Provider Demographics
NPI:1992190102
Name:RAYNISH, STEPHANIE (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:RAYNISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:GASPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2020 E STATE ST STE C
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-2479
Mailing Address - Country:US
Mailing Address - Phone:330-332-7807
Mailing Address - Fax:330-332-7809
Practice Address - Street 1:2020 E STATE ST STE C
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2479
Practice Address - Country:US
Practice Address - Phone:330-332-7807
Practice Address - Fax:330-332-7809
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH35-133878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH57.026659OtherOHIO TRAINING LICENSE NUMBER