Provider Demographics
NPI:1093814220
Name:RAMBASEK, TODD EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:EDWARD
Last Name:RAMBASEK
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:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-609-1112
Mailing Address - Fax:419-502-3537
Practice Address - Street 1:2800 HAYES AVE BLDG C
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7251
Practice Address - Country:US
Practice Address - Phone:419-609-1800
Practice Address - Fax:419-609-1808
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079496207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRA2463187Medicaid
OH1952401226OtherNPI
OHP00217583OtherMEDICARE RAILROAD
OHP00217583OtherMEDICARE RAILROAD
OHRA2463187Medicaid