Healthcare Provider Details

I. General information

NPI: 1497788897
Provider Name (Legal Business Name): RAFAEL A NIVAR-ARISTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 DELAWARE AVE
MARION OH
43302-6416
US

IV. Provider business mailing address

PO BOX 1816
MARION OH
43301-1816
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-7000
  • Fax: 740-383-7942
Mailing address:
  • Phone: 740-383-7000
  • Fax: 740-383-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number35057879
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: