Healthcare Provider Details

I. General information

NPI: 1528375839
Provider Name (Legal Business Name): BALGOPAL ERADI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE CINCINNATI CHILDRENS HOSPITAL MEDICAL CENTRE
CINCINNATI OH
45229
US

IV. Provider business mailing address

1216 PAXTON AVE
CINCINNATI OH
45208-2833
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4200
  • Fax:
Mailing address:
  • Phone: 513-321-1970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number57.017437
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: