Provider Demographics
NPI:1487868550
Name:RABIN, MARK (PHD FACMG)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:RABIN
Suffix:
Gender:M
Credentials:PHD FACMG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 COPPER BEECH DR
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2953
Mailing Address - Country:US
Mailing Address - Phone:203-314-5046
Mailing Address - Fax:
Practice Address - Street 1:DIANON SYSTEMS
Practice Address - Street 2:200 WATSON BOULEVARD
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615
Practice Address - Country:US
Practice Address - Phone:203-380-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCQP33537170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics