Provider Demographics
NPI:1033198171
Name:BRIJAWI, BASHAR (MD)
Entity Type:Individual
Prefix:
First Name:BASHAR
Middle Name:
Last Name:BRIJAWI
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 1:3301 MERCY HEALTH BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-1105
Mailing Address - Country:US
Mailing Address - Phone:513-559-7025
Mailing Address - Fax:513-981-5755
Practice Address - Street 1:3301 MERCY HEALTH BLVD STE 300
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1109
Practice Address - Country:US
Practice Address - Phone:513-559-7025
Practice Address - Fax:513-981-5755
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY363192084N0400X, 2084S0012X
OH350817702084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000309964OtherANTHEM
OH00212115OtherRR MEDICARE
KY64047111Medicaid
OH2344305Medicaid
OH000000309964OtherANTHEM
H58190Medicare UPIN
KY64047111Medicaid
OH4110526Medicare PIN
KY0960901Medicare PIN