Provider Demographics
NPI:1588719462
Name:QUTAB, RAFFIA (MD)
Entity type:Individual
Prefix:
First Name:RAFFIA
Middle Name:
Last Name:QUTAB
Suffix:
Gender:F
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:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01543-0045
Mailing Address - Country:US
Mailing Address - Phone:508-886-6500
Mailing Address - Fax:508-886-6501
Practice Address - Street 1:694 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1862
Practice Address - Country:US
Practice Address - Phone:508-886-6500
Practice Address - Fax:508-886-6501
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1588719462OtherNPI