Provider Demographics
NPI:1255511655
Name:RITA PABLA MD
Entity type:Organization
Organization Name:RITA PABLA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PABLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-725-0037
Mailing Address - Street 1:13621 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5095
Mailing Address - Country:US
Mailing Address - Phone:301-725-0037
Mailing Address - Fax:301-725-7885
Practice Address - Street 1:13621 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5095
Practice Address - Country:US
Practice Address - Phone:301-725-0037
Practice Address - Fax:301-725-7885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047707207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00648Medicare PIN