Healthcare Provider Details

I. General information

NPI: 1730611096
Provider Name (Legal Business Name): RAJAN N GANESH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 EASTLAND AVE SE STE 301
WARREN OH
44484-4501
US

IV. Provider business mailing address

627 EASTLAND AVE SE STE 301
WARREN OH
44484-4501
US

V. Phone/Fax

Practice location:
  • Phone: 330-841-4535
  • Fax: 330-395-1721
Mailing address:
  • Phone: 330-841-4535
  • Fax: 330-395-1721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number97235
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.155876
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: