Healthcare Provider Details

I. General information

NPI: 1578949517
Provider Name (Legal Business Name): MUJIB RAHMAN MD MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 E MARKET ST UNIT B
WARREN OH
44483-6266
US

IV. Provider business mailing address

1606 AVALON CREEK BLVD
VIENNA OH
44473-9558
US

V. Phone/Fax

Practice location:
  • Phone: 330-766-0138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35094687
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number35094687
License Number StateOH

VIII. Authorized Official

Name: MUHAMMAD MUJIBUR RAHMAN
Title or Position: MD/OWNER
Credential: MD
Phone: 330-766-0138