Healthcare Provider Details

I. General information

NPI: 1265515662
Provider Name (Legal Business Name): JAGDESH KANDALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/14/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MATTHEW ST STE 302
MARIETTA OH
45750-1656
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 740-568-5207
  • Fax: 740-568-5297
Mailing address:
  • Phone: 800-223-2273
  • Fax: 800-223-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.144262
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35.144262
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number290180
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: