1609851013 NPI number — MITA RAHEJA MD FACC

Table of content: MITA RAHEJA MD FACC (NPI 1609851013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609851013 NPI number — MITA RAHEJA MD FACC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAHEJA
Provider First Name:
MITA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD FACC
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:
1609851013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6855
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44501-6855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-759-8169
Provider Business Mailing Address Fax Number:
330-759-8306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3622 BELMONT AVE
Provider Second Line Business Practice Location Address:
SUITES 11 AND 12
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44505-1450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-759-8169
Provider Business Practice Location Address Fax Number:
330-759-8306
Provider Enumeration Date:
12/08/2005

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: 207RC0001X , with the licence number:  35065143 , 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: 110228843 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 341949665027 . This is a "CARESOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000104933 . This is a "UNISON HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1542907 . This is a "GATEWAY HEALTH PLAN OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1542907 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2500890 . This is a "UNITEDHEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000205226 . This is a "ANTHEM BLUE CROSS AND BLUE SHIELD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0964774 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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