Provider Demographics
NPI:1487845129
Name:RABBANI, FIROUZEH (MD)
Entity Type:Individual
Prefix:DR
First Name:FIROUZEH
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 1:2210 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4648
Mailing Address - Country:US
Mailing Address - Phone:812-945-4000
Mailing Address - Fax:812-941-5714
Practice Address - Street 1:2210 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4648
Practice Address - Country:US
Practice Address - Phone:812-945-4000
Practice Address - Fax:812-941-5714
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62516174400000X
IN01049985A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400059676Medicare PIN
CAH01858Medicare UPIN