Provider Demographics
NPI:1356742407
Name:REESHAD R BUHARIWALLA, MD INC
Entity type:Organization
Organization Name:REESHAD R BUHARIWALLA, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:ASHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-394-4813
Mailing Address - Street 1:4090 ACADIA ROAD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833
Mailing Address - Country:US
Mailing Address - Phone:419-394-4813
Mailing Address - Fax:
Practice Address - Street 1:4090 ACADIA RD
Practice Address - Street 2:
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-9410
Practice Address - Country:US
Practice Address - Phone:419-394-4813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068953261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0217269Medicaid
OH8953Medicaid
OH0217269Medicaid
OH8953Medicaid