Provider Demographics
NPI:1154391647
Name:RAVICHANDRAN, KAMALESWARY (MD)
Entity type:Individual
Prefix:DR
First Name:KAMALESWARY
Middle Name:
Last Name:RAVICHANDRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10325 DEWHURST RD
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-8403
Mailing Address - Country:US
Mailing Address - Phone:440-414-9260
Mailing Address - Fax:216-201-5581
Practice Address - Street 1:10325 DEWHURST RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-8403
Practice Address - Country:US
Practice Address - Phone:440-414-9260
Practice Address - Fax:216-201-5581
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078860207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE7886OtherSUMMA
P00227203OtherRAILROAD MEDICARE
OH000000364129OtherANTHEM
OH2228575Medicaid
OH000000364129OtherANTHEM
OHRA4043903Medicare ID - Type Unspecified