MEDICARE: DR. RAVINDER NATH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35042959	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003882507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAVINDER NATH MD

Provider Business Mailing Address
First Line	:	1280 BOARDMAN CANFIELD ROAD
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-4073
Country	:	US
Telephone Number	:	330-726-9582
Fax Number	:	330-726-9769

Provider Business Practice Location Address
First Line	:	1280 BOARDMAN CANFIELD ROAD
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-4073
Country	:	US
Telephone Number	:	330-726-9582
Fax Number	:	330-726-9769

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	02/10/2009

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