Provider Demographics
NPI:1821089442
Name:RABER, DANIELLE NICHOLE (MD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NICHOLE
Last Name:RABER
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:PO BOX 72098
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192-4011
Mailing Address - Country:US
Mailing Address - Phone:419-281-8079
Mailing Address - Fax:
Practice Address - Street 1:1941 BANEY RD S
Practice Address - Street 2:ASHLAND FAMILY PRACTICE/SAMARITAN PROFESSIONAL CORP
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4502
Practice Address - Country:US
Practice Address - Phone:419-289-0333
Practice Address - Fax:419-281-7903
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH70921208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2652428Medicaid