1841273216 NPI number — DR. ALI A RAHIMIAN MD

Table of content: DR. ALI A RAHIMIAN MD (NPI 1841273216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841273216 NPI number — DR. ALI A RAHIMIAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAHIMIAN
Provider First Name:
ALI
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1841273216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26302-2308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-622-1264
Provider Business Mailing Address Fax Number:
304-622-0204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 DAVISSON RUN RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
CLARKSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26301-9304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-622-1264
Provider Business Practice Location Address Fax Number:
304-622-0204
Provider Enumeration Date:
11/21/2005

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: 207V00000X , with the licence number:  11608 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 245004 . This is a "CARELINK/COVENTRY" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: WV11608D . This is a "HEALTH PLAN #" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 5116317 . This is a "ALLIANCE PROVIDER #" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0094094000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5116317 . This is a "MAMSI PROVIDER #" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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