Healthcare Provider Details

I. General information

NPI: 1780414367
Provider Name (Legal Business Name): ABHIJIT S RAO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 COLONEL GLENN HWY
DAYTON OH
45435-0001
US

IV. Provider business mailing address

6438 FOX AND HOUND CT
MASON OH
45040-8026
US

V. Phone/Fax

Practice location:
  • Phone: 513-587-8699
  • Fax:
Mailing address:
  • Phone: 513-827-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: