Provider Demographics
NPI:1578085593
Name:ELTAF, RABIA
Entity Type:Individual
Prefix:
First Name:RABIA
Middle Name:
Last Name:ELTAF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 N POINT RD
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1605
Mailing Address - Country:US
Mailing Address - Phone:410-284-6665
Mailing Address - Fax:410-284-2995
Practice Address - Street 1:1010 S NORTHPOINT RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3307
Practice Address - Country:US
Practice Address - Phone:410-282-5561
Practice Address - Fax:410-282-5562
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist