Basic Information
| Provider Information | |||||||||
| NPI: | 1053342592 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RABBITT | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6355 WALKER LN | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223103245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037654321 | ||||||||
| FaxNumber: | 7039710958 | ||||||||
| Practice Location | |||||||||
| Address1: | 6355 WALKER LN | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223103245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037654321 | ||||||||
| FaxNumber: | 7039710958 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 03/22/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | D0030644 | MD | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 0101036585 | VA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD14460 | DC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 342721800 | 05 | MD | MEDICAID | 39689 | 01 | MDIPA/OPT CH/MAMSI PROV# | OTHER | 200028366 | 01 | MD | RAILROAD MEDICARE | OTHER | 419539 | 01 | MD | CAREFIRST MARYLAND PROV# | OTHER | 46950005 | 01 | DC | CAREFIRST NCA | OTHER |