Provider Demographics
NPI:1578615480
Name:MOKABBERI, RASOUL (MD)
Entity Type:Individual
Prefix:
First Name:RASOUL
Middle Name:
Last Name:MOKABBERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:GEISINGER MEDICAL CENTER
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-9800
Mailing Address - Country:US
Mailing Address - Phone:216-269-2654
Mailing Address - Fax:570-271-1702
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:GEISINGER MEDICAL CENTER
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-9800
Practice Address - Country:US
Practice Address - Phone:216-269-2654
Practice Address - Fax:570-271-1702
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35089082207R00000X
CAA 95258207RC0000X
PAMD 435510207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTAX IDENTIFICATIONOther341898545
OH35089082OtherLICENSE
PAMD 435510OtherLICENSE
CAA 95258OtherLICENSE