Provider Demographics
NPI:1740246743
Name:BERHANE, RAHEL (MD)
Entity type:Individual
Prefix:
First Name:RAHEL
Middle Name:
Last Name:BERHANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1301 BARBARA JORDAN BLVD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3077
Mailing Address - Country:US
Mailing Address - Phone:512-628-1898
Mailing Address - Fax:512-600-8149
Practice Address - Street 1:7020 EASY WIND DR STE 130
Practice Address - Street 2:SUITE #400
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-2361
Practice Address - Country:US
Practice Address - Phone:512-628-1898
Practice Address - Fax:512-600-8149
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK13632080P0206X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144469701Medicaid
TXF62143Medicare UPIN
TX8L27301Medicare PIN