Provider Demographics
NPI:1104943133
Name:PASHA, JASEEM (MD)
Entity type:Individual
Prefix:DR
First Name:JASEEM
Middle Name:
Last Name:PASHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 FURMAN DR
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-9775
Mailing Address - Country:US
Mailing Address - Phone:937-890-4447
Mailing Address - Fax:937-890-7136
Practice Address - Street 1:1520 GERMANTOWN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408-1318
Practice Address - Country:US
Practice Address - Phone:937-222-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH351000182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0371673Medicaid
OH0371673Medicaid
OHAP6361505OtherDEA NUMBER
OH0371673Medicaid