Provider Demographics
NPI:1790893683
Name:RASUL, MAZHAR (MD)
Entity Type:Individual
Prefix:
First Name:MAZHAR
Middle Name:
Last Name:RASUL
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 1:204 SOMERSLY PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5718
Mailing Address - Country:US
Mailing Address - Phone:859-552-1757
Mailing Address - Fax:
Practice Address - Street 1:204 SOMERSLY PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-5718
Practice Address - Country:US
Practice Address - Phone:859-552-1757
Practice Address - Fax:859-552-1757
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-082552207L00000X, 208VP0000X
KY37590207L00000X, 208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64067176Medicaid
KY000000304991OtherANTHEM
OH2475802Medicaid
KYP00013479OtherRR MEDICARE
KYK227370Medicare PIN
KYH84693Medicare UPIN
KY64067176Medicaid
KY0666921Medicare UPIN
KYP00013479OtherRR MEDICARE