Provider Demographics
NPI:1255642955
Name:RAINES, JOSHUA D (DO)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:D
Last Name:RAINES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3515 MASSILLON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7854
Mailing Address - Country:US
Mailing Address - Phone:330-899-9350
Mailing Address - Fax:330-634-1329
Practice Address - Street 1:251 LEATHERMAN RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9236
Practice Address - Country:US
Practice Address - Phone:330-334-6229
Practice Address - Fax:330-334-6110
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.010864207Q00000X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0102518OtherJOSHUA D. RAINES, DO MEDICAID ID
OH1255642955OtherJOSHUA D. RAINES, DO MEDICARE ID