Provider Demographics
NPI:1003852070
Name:RAE, ROBERT SEAN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SEAN
Last Name:RAE
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 1:6121 COLERAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-6417
Mailing Address - Country:US
Mailing Address - Phone:513-354-2466
Mailing Address - Fax:
Practice Address - Street 1:6121 COLERAIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-6417
Practice Address - Country:US
Practice Address - Phone:513-354-2466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.088334207R00000X, 208M00000X
OH35088334207QA0505X, 207R00000X
WV30101207R00000X
PAMD475080207R00000X
MO2021028442207R00000X
MI4301080667207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000497140OtherANTHEM
OH06186OtherPARAMOUNT
MI4997740Medicaid
OH7861831OtherAETNA
OHP00434160OtherRRMC
OH2677063Medicaid
OH297706983OtherTRICARE
OH000000522443OtherANTHEM
OH2677063Medicaid
OHP00434160OtherRRMC
OH297706983OtherTRICARE