1447295191 NPI number — DR. AVIVA H RASKAS M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447295191 NPI number — DR. AVIVA H RASKAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RASKAS
Provider First Name:
AVIVA
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1447295191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 957723
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63195-7723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-432-2580
Provider Business Mailing Address Fax Number:
314-569-3162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8420 DELMAR BLVD
Provider Second Line Business Practice Location Address:
505
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63124-2170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-749-6621
Provider Business Practice Location Address Fax Number:
314-569-3162
Provider Enumeration Date:
06/17/2006

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: 174400000X , with the licence number:  2002011264 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 2002011264 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201422 . This is a "BLUECHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P00278493 . This is a "INDIVIDUAL PROV#" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 201766046 . This is a "TAX ID#" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 201911 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 207205501 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 266892 . This is a "GHP/CMR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 731022 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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