Basic Information
| Provider Information | |||||||||
| NPI: | 1114912631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RABINE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2411 W BELVEDERE AVE STE 308 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212155230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106015392 | ||||||||
| FaxNumber: | 4106017854 | ||||||||
| Practice Location | |||||||||
| Address1: | 2411 W BELVEDERE AVE STE 308 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106015392 | ||||||||
| FaxNumber: | 4106017854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 09/20/2018 | ||||||||
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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 | 207RG0100X | Q6088 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 8FY260 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 017791100 | 05 | MD | MEDICAID | 361007301 | 05 | TX | MEDICAID | P01733202 | 01 | TX | RAILROAD MEDICARE | OTHER |