Healthcare Provider Details

I. General information

NPI: 1295939734
Provider Name (Legal Business Name): RUPESH RAINA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W EXCHANGE ST
AKRON OH
44302-1704
US

IV. Provider business mailing address

20455 LORAIN RD STE T-01
FAIRVIEW PARK OH
44126-3494
US

V. Phone/Fax

Practice location:
  • Phone: 330-436-3150
  • Fax: 330-436-3160
Mailing address:
  • Phone: 440-799-4224
  • Fax: 440-799-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number35090282
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35.090282
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: