Healthcare Provider Details

I. General information

NPI: 1164586715
Provider Name (Legal Business Name): RICHLAND CARDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S TRIMBLE RD SUITE B2
MANSFIELD OH
44907-2200
US

IV. Provider business mailing address

1221 S TRIMBLE RD SUITE B2
MANSFIELD OH
44907-2200
US

V. Phone/Fax

Practice location:
  • Phone: 419-631-7183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35056352
License Number StateOH

VIII. Authorized Official

Name: PAMMAL SURESH
Title or Position: MD
Credential:
Phone: 419-631-7183