Provider Demographics
NPI:1992760052
Name:RAKHMAN, DILARA (MD)
Entity type:Individual
Prefix:
First Name:DILARA
Middle Name:
Last Name:RAKHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DILARA
Other - Middle Name:
Other - Last Name:RAKHMANOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2704 GLENWOOD RD
Mailing Address - Street 2:MARK B. LEW, MD, LLC
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2326
Mailing Address - Country:US
Mailing Address - Phone:718-859-6440
Mailing Address - Fax:718-434-0368
Practice Address - Street 1:2704 GLENWOOD RD
Practice Address - Street 2:MARK B. LEW, MD, LLC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2326
Practice Address - Country:US
Practice Address - Phone:718-859-6440
Practice Address - Fax:718-434-0368
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2287532080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02471887Medicaid