Provider Demographics
NPI:1568612315
Name:BAISHNAB, RAMAN DAVID (DO)
Entity Type:Individual
Prefix:
First Name:RAMAN
Middle Name:DAVID
Last Name:BAISHNAB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18780 BAGLEY RD, STE 320
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3349
Mailing Address - Country:US
Mailing Address - Phone:440-816-8200
Mailing Address - Fax:440-816-8197
Practice Address - Street 1:18780 BAGLEY RD
Practice Address - Street 2:STE 320
Practice Address - City:MIDDLEBURG HTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3304
Practice Address - Country:US
Practice Address - Phone:440-816-8200
Practice Address - Fax:440-816-8197
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34 0100012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0071188Medicaid
OHH078706Medicare PIN