=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629066055
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OHIO CARDIOLOGY ASSOCIATES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2005
-----------------------------------------------------
Last Update Date | 07/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2322 E 22ND ST STE 305
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44115-3176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-861-5747
-----------------------------------------------------
Fax | 218-861-5749
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10850 PEARL RD STE D-2
-----------------------------------------------------
City | STRONGSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44136-3305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-572-1628
-----------------------------------------------------
Fax | 440-572-1919
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. JAYATI GUPTA RAKHIT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 216-861-5747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------