Provider Demographics
NPI:1639570583
Name:RODEEN RAHBAR MD LLC
Entity Type:Organization
Organization Name:RODEEN RAHBAR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-679-5773
Mailing Address - Street 1:1010 WAYNE AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-5600
Mailing Address - Country:US
Mailing Address - Phone:301-679-5773
Mailing Address - Fax:301-679-5773
Practice Address - Street 1:1010 WAYNE AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-5600
Practice Address - Country:US
Practice Address - Phone:301-679-5773
Practice Address - Fax:301-679-5773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00763472086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1912087453OtherNPI ENTITY TYPE 1