Provider Demographics
NPI:1598798225
Name:JABIR, RIZWAN (MD)
Entity Type:Individual
Prefix:
First Name:RIZWAN
Middle Name:
Last Name:JABIR
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:ROUTE 403 SOUTH
Mailing Address - Street 2:PO BOX 268
Mailing Address - City:MARION CENTER
Mailing Address - State:PA
Mailing Address - Zip Code:15759
Mailing Address - Country:US
Mailing Address - Phone:724-397-2326
Mailing Address - Fax:724-397-2420
Practice Address - Street 1:ROUTE 403 SOUTH
Practice Address - Street 2:100 NEALE AVENUE
Practice Address - City:MARION CENTER
Practice Address - State:PA
Practice Address - Zip Code:15759
Practice Address - Country:US
Practice Address - Phone:724-397-2326
Practice Address - Fax:724-397-2420
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058271L2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP000831OtherGATEWAY PROVIDER #
PA0015738130001Medicaid
PA252780OtherUPMC FOR YOU PROV #
PA252780OtherUPMC HEALTH CARE PROV #
PA5109152OtherAETNA/US HEALTHCARE
PA69936OtherUNISON PROVIDER #
PA852808OtherBLUE SHIELD PROVIDER #
PA0015738130006Medicaid
PA0015738130001Medicaid