Provider Demographics
NPI:1629068143
Name:OLSHAKER, ROBERT A (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:OLSHAKER
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 1:5655 HUDSON DR STE 210
Mailing Address - Street 2:ARIS RADIOLOGY
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4455
Mailing Address - Country:US
Mailing Address - Phone:330-655-1869
Mailing Address - Fax:330-688-3828
Practice Address - Street 1:2300 OPITZ BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3311
Practice Address - Country:US
Practice Address - Phone:703-670-1561
Practice Address - Fax:703-670-4961
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010482372085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010128684Medicaid
DCP00212165OtherRAILROAD MEDICARE
F45531Medicare UPIN
006600P33Medicare ID - Type Unspecified