Provider Demographics
NPI:1457332405
Name:RABIN, MARK ALAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:RABIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2375 WOODWARD ST
Mailing Address - Street 2:SUITE 111N
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-5120
Mailing Address - Country:US
Mailing Address - Phone:215-676-7080
Mailing Address - Fax:215-676-7802
Practice Address - Street 1:2375 WOODWARD ST
Practice Address - Street 2:SUITE 111N
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-5120
Practice Address - Country:US
Practice Address - Phone:215-676-7080
Practice Address - Fax:215-676-7802
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2007-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001354L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005067180001Medicaid
T27575Medicare UPIN
PA0005067180001Medicaid