Provider Demographics
NPI:1811060999
Name:RAJJOUB, HASSAN (MD)
Entity type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:RAJJOUB
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 1:1320 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1822
Mailing Address - Country:US
Mailing Address - Phone:220-564-7750
Mailing Address - Fax:220-564-7751
Practice Address - Street 1:1320 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1822
Practice Address - Country:US
Practice Address - Phone:220-564-7750
Practice Address - Fax:220-564-7751
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081366207RC0000X, 207RI0011X
OH35.081366207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2353466Medicaid
OH9339883Medicare PIN
OH9339881Medicare PIN
OHH31576Medicare UPIN
OHRA4088416Medicare PIN
OH2353466Medicaid
OHH022252Medicare PIN