Basic Information
| Provider Information | |||||||||
| NPI: | 1073595021 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | RATHOD | ||||||||
| FirstName: | ASHA | ||||||||
| MiddleName: | HARDAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 MEDICAL VILLAGE DRIVE SUITE 258 | ||||||||
| Address2: | MILLENIUM ANESTHESIA LLC | ||||||||
| City: | EDGEWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593417246 | ||||||||
| FaxNumber: | 8593417867 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 STRAIGHT STREET | ||||||||
| Address2: | MILLENIUM ANESTHESIA LLC | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593417246 | ||||||||
| FaxNumber: | 8593417867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 02/20/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35043119R | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 64788318 | 05 | KY | MEDICAID | 0639376 | 05 | OH | MEDICAID | 000000077604 | 01 | ANTHEM BLUE SHIELD | OTHER |