Provider Demographics
NPI:1417495318
Name:RABER, NATHANAEL ELLIS
Entity Type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:ELLIS
Last Name:RABER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 E CHURCHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-1721
Mailing Address - Country:US
Mailing Address - Phone:410-734-6556
Mailing Address - Fax:410-734-6557
Practice Address - Street 1:2304 E CHURCHVILLE RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-1721
Practice Address - Country:US
Practice Address - Phone:410-734-6556
Practice Address - Fax:410-734-6557
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26349225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist