Healthcare Provider Details

I. General information

NPI: 1982656005
Provider Name (Legal Business Name): BELAGODU N KANTHARAJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41201 SCHADDEN ROAD SUITE 2
ELYRIA OH
44035-2220
US

IV. Provider business mailing address

36446 N RESERVE CIR
AVON OH
44011-2820
US

V. Phone/Fax

Practice location:
  • Phone: 440-324-0401
  • Fax: 440-324-0405
Mailing address:
  • Phone: 440-823-5966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number46026
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number46026
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: