Provider Demographics
NPI:1841277670
Name:KAZLAUSKAS, RITA R (MD)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:R
Last Name:KAZLAUSKAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7452 FULTON DR NW
Mailing Address - Street 2:STE. B
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-9393
Mailing Address - Country:US
Mailing Address - Phone:330-833-4596
Mailing Address - Fax:330-833-1817
Practice Address - Street 1:7452 FULTON DR NW
Practice Address - Street 2:STE. B
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-9393
Practice Address - Country:US
Practice Address - Phone:330-833-4596
Practice Address - Fax:330-833-1817
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35061459208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0823345Medicaid
OH4285951Medicare PIN