Provider Demographics
NPI:1467447045
Name:RASHBAUM, STEPHEN J (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:RASHBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HOSPITAL BLVD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4907
Mailing Address - Country:US
Mailing Address - Phone:770-410-4346
Mailing Address - Fax:770-410-4349
Practice Address - Street 1:2500 HOSPITAL BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4907
Practice Address - Country:US
Practice Address - Phone:770-410-4346
Practice Address - Fax:770-410-4349
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001261207RG0100X
GA0056918207RG0100X
CAG87629207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA693367887AMedicaid
NC8930664Medicaid
GA693367887AMedicaid
NC2191090Medicare ID - Type Unspecified
GAP00811505Medicare PIN