Provider Demographics
NPI:1851336705
Name:MARK A. RABIN DPM ASSOCIATES
Entity Type:Organization
Organization Name:MARK A. RABIN DPM ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:RABIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-676-7080
Mailing Address - Street 1:2375 WOODWARD ST
Mailing Address - Street 2:SUITE 111N
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-5120
Mailing Address - Country:US
Mailing Address - Phone:215-676-7080
Mailing Address - Fax:215-676-7802
Practice Address - Street 1:2375 WOODWARD ST
Practice Address - Street 2:SUITE 111N
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-5120
Practice Address - Country:US
Practice Address - Phone:215-676-7080
Practice Address - Fax:215-676-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001354L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009945550001Medicaid
PA076707Medicare PIN
PA1009945550001Medicaid
PA0468020001Medicare NSC