Healthcare Provider Details

I. General information

NPI: 1326142803
Provider Name (Legal Business Name): EVA L BHADRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13241 RAVENNA ROAD
CHARDON OH
44024
US

IV. Provider business mailing address

13241 RAVENNA ROAD
CHARDON OH
44024
US

V. Phone/Fax

Practice location:
  • Phone: 440-285-9166
  • Fax: 440-285-1806
Mailing address:
  • Phone: 440-285-9166
  • Fax: 440-285-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35069440
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: