Provider Demographics
NPI:1003864752
Name:VASI, RAHIB N (MD)
Entity Type:Individual
Prefix:
First Name:RAHIB
Middle Name:N
Last Name:VASI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 NILLES RD
Mailing Address - Street 2:STE C
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2621
Mailing Address - Country:US
Mailing Address - Phone:513-863-6001
Mailing Address - Fax:513-863-0462
Practice Address - Street 1:311 NILLES RD
Practice Address - Street 2:STE C
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2621
Practice Address - Country:US
Practice Address - Phone:513-863-6001
Practice Address - Fax:513-863-0462
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042940207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0439350Medicaid
OH0439350Medicaid
OHC01941Medicare UPIN
OH0484461Medicare PIN
OH000000015472OtherANTHEM PIN
OH311320138026OtherCARESOURCE PIN