Provider Demographics
NPI:1184797367
Name:RASS, AMJAD A (MD)
Entity type:Individual
Prefix:
First Name:AMJAD
Middle Name:A
Last Name:RASS
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 1:1730 SOUTHGATE PKWY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-3024
Mailing Address - Country:US
Mailing Address - Phone:740-435-8585
Mailing Address - Fax:740-454-0366
Practice Address - Street 1:1730 SOUTHGATE PKWY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-3024
Practice Address - Country:US
Practice Address - Phone:740-435-8585
Practice Address - Fax:740-454-0366
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35077009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHANTHEMOther000000370270
OHUNISONOther000000185209
OH2133775Medicaid
OH000000370270OtherUNICARE
OHC77009OtherHEALTHPLAN
OHP00241709OtherRR MEDICARE
OHRA0891683Medicare ID - Type UnspecifiedOHIO MEDICARE
OH2133775Medicaid