Provider Demographics
NPI:1942233184
Name:RASI, ANTHONY DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:DANIEL
Last Name:RASI
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:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-1300
Mailing Address - Country:US
Mailing Address - Phone:276-322-5400
Mailing Address - Fax:276-322-5557
Practice Address - Street 1:231 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2002
Practice Address - Country:US
Practice Address - Phone:276-322-5400
Practice Address - Fax:276-322-5557
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201307207Q00000X
WV740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD259291ML2OtherMAMSI
WV1022652OtherBRICKSTREET (WV WORK COMP
WV001709761OtherMOUNTAIN STATE BCBS
WV0049569000Medicaid
VA292358OtherANTHEM BCBS
VA005692393Medicaid
VAC08734Medicare PIN
VA00V444A34Medicare PIN
E05930Medicare UPIN
WV0049569000Medicaid
WV407086246Medicare PIN
WV0480673Medicare PIN