1164493052 NPI number — DR. RAMACHANDRAN C RAVICHANDRAN MD

Table of content: DR. RAMACHANDRAN C RAVICHANDRAN MD (NPI 1164493052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164493052 NPI number — DR. RAMACHANDRAN C RAVICHANDRAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAVICHANDRAN
Provider First Name:
RAMACHANDRAN
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAVI
Provider Other First Name:
RAM
Provider Other Middle Name:
C.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164493052
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29325 HEALTH CAMPUS DR STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTLAKE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44145-8201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-414-9400
Provider Business Mailing Address Fax Number:
216-201-5591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29325 HEALTH CAMPUS DR STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTLAKE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44145-8201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-414-9400
Provider Business Practice Location Address Fax Number:
216-201-5591
Provider Enumeration Date:
01/30/2006

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: 207R00000X , with the licence number:  35069332 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110194567 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000128708 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9379701 . This is a "GROUP MEDICARE PTAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: F69332 . This is a "SUMMA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0350043 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01430000 . This is a "MEDICARE RAILROAD INDIVIDUAL PTAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: DO6570 . This is a "MEDICARE RAILROAD GROUP PTAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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