Provider Demographics
NPI:1417993403
Name:RABBANI, MOJDEH (MD)
Entity Type:Individual
Prefix:DR
First Name:MOJDEH
Middle Name:
Last Name:RABBANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 URICO GOLF RD
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-4425
Mailing Address - Country:US
Mailing Address - Phone:352-753-4478
Mailing Address - Fax:
Practice Address - Street 1:711 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5128
Practice Address - Country:US
Practice Address - Phone:352-435-4000
Practice Address - Fax:352-435-4016
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87075207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine