Provider Demographics
NPI:1861457509
Name:BASALI, AYMAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:AYMAN
Middle Name:H
Last Name:BASALI
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 1:27739 S WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44124-5633
Mailing Address - Country:US
Mailing Address - Phone:216-595-1328
Mailing Address - Fax:330-202-5581
Practice Address - Street 1:546 WINTER ST
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2300
Practice Address - Country:US
Practice Address - Phone:330-202-5580
Practice Address - Fax:330-202-5581
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072531B207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH050072220OtherMEDICARE RAILROAD
OH2169264Medicaid
OHG78346Medicare UPIN
OHBA7345201Medicare PIN