Basic Information
| Provider Information | |||||||||
| NPI: | 1003852070 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | SEAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4685 FOREST AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452123397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132461964 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10500 MONTGOMERY RD | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452424402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138652246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 10/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35.08-8334 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207QA0505X | 35088334 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207R00000X | 35088334 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RA0000X | 4301080667 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine | 208M00000X | 35.088334 | OH | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 000000522443 | 01 | OH | ANTHEM | OTHER | 297706983 | 01 | OH | TRICARE | OTHER | 4997740 | 05 | MI | MEDICAID | 7861831 | 01 | OH | AETNA | OTHER | P00434160 | 01 | OH | RRMC | OTHER | 000000497140 | 01 | OH | ANTHEM | OTHER | 06186 | 01 | OH | PARAMOUNT | OTHER | 2677063 | 05 | OH | MEDICAID |