Healthcare Provider Details

I. General information

NPI: 1619917705
Provider Name (Legal Business Name): MARC ANTHONY RASLICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 UNIVERSITY BLVD
DAYTON OH
45435-0001
US

IV. Provider business mailing address

725 UNIVERSITY BLVD
DAYTON OH
45435-0001
US

V. Phone/Fax

Practice location:
  • Phone: 937-560-2273
  • Fax:
Mailing address:
  • Phone: 937-245-7100
  • Fax: 937-245-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-079953
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-079953
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: