Provider Demographics
NPI:1851476147
Name:SHAH, RUBINA HASSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBINA
Middle Name:HASSAN
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7253 AMBASSADOR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2710
Mailing Address - Country:US
Mailing Address - Phone:614-771-2222
Mailing Address - Fax:614-771-2221
Practice Address - Street 1:2658 W. LASKEY ROAD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-3288
Practice Address - Country:US
Practice Address - Phone:419-473-8105
Practice Address - Fax:419-254-2121
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00822392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2366318Medicaid
OH2366318Medicaid
4090441Medicare PIN
OHBS7921770OtherDEA NUMBER
OH2366318Medicaid