Provider Demographics
NPI:1144313354
Name:REHMATULLAH, NASIMULLAH (MD)
Entity type:Individual
Prefix:
First Name:NASIMULLAH
Middle Name:
Last Name:REHMATULLAH
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:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-0219
Mailing Address - Country:US
Mailing Address - Phone:440-593-6433
Mailing Address - Fax:440-593-6900
Practice Address - Street 1:167 W MAIN RD STE C
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2057
Practice Address - Country:US
Practice Address - Phone:440-593-6433
Practice Address - Fax:440-593-6900
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH45903207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA79969Medicare UPIN