Healthcare Provider Details

I. General information

NPI: 1508488636
Provider Name (Legal Business Name): AAYUSH KIRAN PRADHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MARKET ST
BOARDMAN OH
44512-6725
US

IV. Provider business mailing address

8401 MARKET ST
BOARDMAN OH
44512-6725
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-4298
  • Fax: 330-729-1897
Mailing address:
  • Phone: 330-729-4298
  • Fax: 330-729-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.147263
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.147263
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: