1336176882 NPI number — VIDYA K RAMANATHAN M.D.

Table of content: VIDYA K RAMANATHAN M.D. (NPI 1336176882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336176882 NPI number — VIDYA K RAMANATHAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMANATHAN
Provider First Name:
VIDYA
Provider Middle Name:
K
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:
1336176882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE SEAGATE
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43604-1558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-824-7451
Provider Business Mailing Address Fax Number:
419-824-7359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 BRIGHAM DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PERRYSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43551-7114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-872-7700
Provider Business Practice Location Address Fax Number:
419-874-0196
Provider Enumeration Date:
06/27/2006

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: 208000000X , with the licence number:  35-093203 , 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: 104768362 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0068764 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: VK085434 . This is a "BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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