Healthcare Provider Details

I. General information

NPI: 1730130626
Provider Name (Legal Business Name): LALITH K MISRA DO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 S PROSPECT ST STE 3
MARION OH
43302-6283
US

IV. Provider business mailing address

# L-3652
COLUMBUS OH
43260-6453
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-7910
  • Fax: 740-375-8129
Mailing address:
  • Phone: 740-383-7927
  • Fax: 740-383-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34.007451
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: