1679730162 NPI number — ROJA CHIMAKURTHI M.D.

Table of content: ROJA CHIMAKURTHI M.D. (NPI 1679730162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679730162 NPI number — ROJA CHIMAKURTHI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIMAKURTHI
Provider First Name:
ROJA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679730162
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4600 MONTGOMERY RD
Provider Second Line Business Mailing Address:
STE 105
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45212-2697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-487-5305
Provider Business Mailing Address Fax Number:
513-487-5317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
STE 360
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45005-5200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-217-5720
Provider Business Practice Location Address Fax Number:
513-217-5729
Provider Enumeration Date:
05/21/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  35.129555 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RN0300X , with the licence number: 49460 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 037560800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 974970-01 . This is a "CAREFIRST BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: S062-0440 . This is a "CAREFIRST BC/BS - REGIONAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".