Basic Information
| Provider Information | |||||||||
| NPI: | 1205849304 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIMAWI | ||||||||
| FirstName: | ROLA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 CHESTNUT ST | ||||||||
| Address2: | 14TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191064404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 2159552420 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 FORD RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191312039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158799346 | ||||||||
| FaxNumber: | 2158799082 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 02/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 229695 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD432520 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0183768 | 05 | NJ | MEDICAID | 1022395540001 | 05 | PA | MEDICAID |