Provider Demographics
NPI:1174777882
Name:ANG RABANES, GERALDINE B (MD)
Entity type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:B
Last Name:ANG RABANES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GERALDINE
Other - Middle Name:RUIVIVAR
Other - Last Name:BACANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3755 E VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3238
Mailing Address - Country:US
Mailing Address - Phone:757-664-7699
Mailing Address - Fax:
Practice Address - Street 1:3755 E VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3238
Practice Address - Country:US
Practice Address - Phone:757-664-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010521852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7105282Medicaid
VA7105282Medicaid
VA260002236Medicare UPIN