1366443343 NPI number — GHULAM RABBANI AZIZ M.D.

Table of content: GHULAM RABBANI AZIZ M.D. (NPI 1366443343)

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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