MEDICARE: DR. BASHAR A. MUBASHIR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	35036620	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0640351	OTHER	OH	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336135474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BASHAR A. MUBASHIR M.D.

Provider Business Mailing Address
First Line	:	6847 N CHESTNUT ST STE 310
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-3929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6847 N CHESTNUT ST STE 310
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-3929
Country	:	US
Telephone Number	:	330-253-9052
Fax Number	:	330-253-9612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	12/29/2020

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