Provider Demographics
NPI:1386628121
Name:RAPAPORT, MARVIN J (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:J
Last Name:RAPAPORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 N BEDFORD DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4310
Mailing Address - Country:US
Mailing Address - Phone:310-274-4401
Mailing Address - Fax:310-274-5194
Practice Address - Street 1:436 N BEDFORD DR
Practice Address - Street 2:SUITE 306
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4310
Practice Address - Country:US
Practice Address - Phone:310-274-4401
Practice Address - Fax:310-274-5194
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG8698174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG8698OtherSTATE LICENSE
CAA58584Medicare UPIN
CAG8698OtherSTATE LICENSE