Healthcare Provider Details

I. General information

NPI: 1912196114
Provider Name (Legal Business Name): AISHA RAHMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 12/29/2024
Certification Date: 12/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6659 FRANK AVE NW
NORTH CANTON OH
44720-7259
US

IV. Provider business mailing address

6659 FRANK AVE NW
NORTH CANTON OH
44720-7259
US

V. Phone/Fax

Practice location:
  • Phone: 330-623-7100
  • Fax: 330-232-9924
Mailing address:
  • Phone: 330-623-7100
  • Fax: 330-232-9924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.097087
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number060088
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number35.097087
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: