Healthcare Provider Details

I. General information

NPI: 1609005578
Provider Name (Legal Business Name): DAKSHIN GANGADHARAMURTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAKSHINAMURTHY GANGADHARAMURTHY M.D.

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 12/04/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7677 YANKEE STREET SUITE 140
WASHINGTON TOWNSHIP OH
45459
US

IV. Provider business mailing address

7677 YANKEE STREET SUITE 140
WASHINGTON TOWNSHIP OH
45459
US

V. Phone/Fax

Practice location:
  • Phone: 937-424-0012
  • Fax: 937-424-0077
Mailing address:
  • Phone: 937-424-0012
  • Fax: 937-424-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.138598
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: