Provider Demographics
NPI:1932841558
Name:RABIDOU, SPENCER JOHN
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:JOHN
Last Name:RABIDOU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HERRICK ST STE 219
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5900
Mailing Address - Country:US
Mailing Address - Phone:978-927-0714
Mailing Address - Fax:
Practice Address - Street 1:75 HERRICK ST STE 219
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5900
Practice Address - Country:US
Practice Address - Phone:978-927-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA8832363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant