Provider Demographics
NPI:1306268966
Name:RABEN, MARIAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:
Last Name:RABEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 ORLEANS ST
Mailing Address - Street 2:CRB I 1M 50-A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0013
Mailing Address - Country:US
Mailing Address - Phone:410-502-3421
Mailing Address - Fax:410-614-8160
Practice Address - Street 1:1650 ORLEANS ST
Practice Address - Street 2:CRB I 1M 50-A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0013
Practice Address - Country:US
Practice Address - Phone:410-502-3421
Practice Address - Fax:410-614-8160
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0000998363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant