Basic Information
Provider Information
NPI: 1205356615
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FABER
FirstName: RACHEL
MiddleName: MARIE
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1119
Address2:  
City: PROVIDENCE
State: RI
PostalCode: 029011119
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2 DUDLEY ST STE 200
Address2:  
City: PROVIDENCE
State: RI
PostalCode: 029053248
CountryCode: US
TelephoneNumber: 4014571500
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/27/2017
LastUpdateDate: 07/22/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/22/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000XMD18341RIY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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