Provider Demographics
NPI:1609102771
Name:TABASSUM, RANA (MD)
Entity Type:Individual
Prefix:
First Name:RANA
Middle Name:
Last Name:TABASSUM
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 1:8243 WILD OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-2845
Mailing Address - Country:US
Mailing Address - Phone:727-593-5638
Mailing Address - Fax:
Practice Address - Street 1:8243 WILD OAKS CIR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-2845
Practice Address - Country:US
Practice Address - Phone:727-593-5638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105727208000000X
KY34096208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics