1366443343 NPI number — GHULAM RABBANI AZIZ M.D.

Table of content: (NPI 1366099269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366443343 NPI number — GHULAM RABBANI AZIZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AZIZ
Provider First Name:
GHULAM
Provider Middle Name:
RABBANI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366443343
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16218 SAINT CLAIR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST LIVERPOOL
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43920-9449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-382-9355
Provider Business Mailing Address Fax Number:
330-382-9448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16218 SAINT CLAIR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LIVERPOOL
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43920-9449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-382-9355
Provider Business Practice Location Address Fax Number:
330-382-9448
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  OH35079747A , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: OH35-07-9747A , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: OH37079747A , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1408622 . This is a "HIGHMARK BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4348701 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 753020102 . This is a "FLORA HEATLH NETWORK/PPOM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 753020102001 . This is a "MOUNTAIN STATE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90768 . This is a "NATIONWIDE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1807927000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 753020102 . This is a "HEALTH AMERICA/ASSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 753020102 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 753020102 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2254984 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5246690 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 753020102 . This is a "PRIMARY HEATLH SERVICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000218659 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 753020102 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P79747A . This is a "MOUNTAIN HEALT TRUST" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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