=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972441558
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAZAN QASHOU
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2026
-----------------------------------------------------
Last Update Date | 03/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4439 STATE ROUTE 159 STE 150
-----------------------------------------------------
City | CHILLICOTHEE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45601-7833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-779-7070
-----------------------------------------------------
Fax | 740-779-8449
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6920 BROOKLYN CT APT 7B
-----------------------------------------------------
City | EVANSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47715-8177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-476-4030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 57.259846
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------