Healthcare Provider Details

I. General information

NPI: 1861744732
Provider Name (Legal Business Name): SANGITA AJAY PADMALWAR MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 12/09/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 GRANVILLE PIKE
LANCASTER OH
43130
US

IV. Provider business mailing address

615 ELSINORE PL STE 200
CINCINNATI OH
45202-1457
US

V. Phone/Fax

Practice location:
  • Phone: 740-653-2500
  • Fax: 740-653-2552
Mailing address:
  • Phone: 513-834-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberCS-0011506
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003597RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: