Provider Demographics
NPI:1447295191
Name:RASKAS, AVIVA H (MD)
Entity type:Individual
Prefix:DR
First Name:AVIVA
Middle Name:H
Last Name:RASKAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 957723
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-7723
Mailing Address - Country:US
Mailing Address - Phone:314-432-2580
Mailing Address - Fax:314-569-3162
Practice Address - Street 1:8420 DELMAR BLVD
Practice Address - Street 2:505
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2170
Practice Address - Country:US
Practice Address - Phone:314-749-6621
Practice Address - Fax:314-569-3162
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002011264174400000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201422OtherBLUECHOICE
MOP00278493OtherINDIVIDUAL PROV#
MO201766046OtherTAX ID#
MO201911OtherBCBS
MO207205501Medicaid
MO266892OtherGHP/CMR
MO731022OtherHEALTHLINK
MO207205501Medicaid
MO266892OtherGHP/CMR