Healthcare Provider Details

I. General information

NPI: 1336176882
Provider Name (Legal Business Name): VIDYA K RAMANATHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 BRIGHAM DR SUITE 200
PERRYSBURG OH
43551-7114
US

IV. Provider business mailing address

ONE SEAGATE SUITE 800
TOLEDO OH
43604-1558
US

V. Phone/Fax

Practice location:
  • Phone: 419-872-7700
  • Fax: 419-874-0196
Mailing address:
  • Phone: 419-824-7451
  • Fax: 419-824-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-093203
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: