Provider Demographics
NPI:1386697472
Name:MOODLEY, SANGITHAN J (MD)
Entity type:Individual
Prefix:
First Name:SANGITHAN
Middle Name:J
Last Name:MOODLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18099 LORAIN AVE
Mailing Address - Street 2:SUITE 345
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5610
Mailing Address - Country:US
Mailing Address - Phone:216-476-7828
Mailing Address - Fax:216-476-4069
Practice Address - Street 1:18099 LORAIN AVE
Practice Address - Street 2:SUITE 345
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5610
Practice Address - Country:US
Practice Address - Phone:216-476-7828
Practice Address - Fax:216-476-4069
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053121207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0612180Medicaid
A82766Medicare UPIN
OH7254911Medicare PIN
OH0612180Medicaid