=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235932096
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADITYA RAI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2025
-----------------------------------------------------
Last Update Date | 10/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2031 BELMONT AVE
-----------------------------------------------------
City | YOUNGSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-480-3605
-----------------------------------------------------
Fax | 330-480-2948
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2031 BELMONT AVE
-----------------------------------------------------
City | YOUNGSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-480-3631
-----------------------------------------------------
Fax | 330-480-2948
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 57.258906
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------