Provider Demographics
NPI:1508831884
Name:ROSTAMI, GITI (MD)
Entity type:Individual
Prefix:
First Name:GITI
Middle Name:
Last Name:ROSTAMI
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 1:2335 BALDWIN DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-6627
Mailing Address - Country:US
Mailing Address - Phone:937-671-6758
Mailing Address - Fax:
Practice Address - Street 1:2335 BALDWIN DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-6627
Practice Address - Country:US
Practice Address - Phone:937-671-6758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063025207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0909888Medicaid
OH0909888Medicaid
OH0726644Medicare PIN