Provider Demographics
NPI:1225513542
Name:RAUCH, DOUGLAS OREN
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:OREN
Last Name:RAUCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6262 YORKTOWN DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-4064
Mailing Address - Country:US
Mailing Address - Phone:480-414-4369
Mailing Address - Fax:
Practice Address - Street 1:6262 YORKTOWN DR.
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-4064
Practice Address - Country:US
Practice Address - Phone:480-414-4369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0296477374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0296477Medicaid