Provider Demographics
NPI:1790931707
Name:DEFATTA, RIMA ABRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:RIMA
Middle Name:ABRAHAM
Last Name:DEFATTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RIMA
Other - Middle Name:FARAJ
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1490 RIVERS EDGE TRL
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2755
Mailing Address - Country:US
Mailing Address - Phone:715-828-2368
Mailing Address - Fax:715-839-7796
Practice Address - Street 1:1490 RIVERS EDGE TRL
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2755
Practice Address - Country:US
Practice Address - Phone:715-828-2368
Practice Address - Fax:715-839-7796
Is Sole Proprietor?:No
Enumeration Date:2008-08-09
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA440103207Y00000X
WI55928207YP0228X, 207YX0602X, 207YX0901X
WI55928-20207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology