MEDICARE: RAVINDER NATH, M.D. INC.

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	35042959N	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	:	1356580179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAVINDER NATH, M.D. INC.

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

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. KATHLEEN M CARLSON
Credential	:
Telephone Number	:	330-726-9582

Provider Enumeration Date	:	02/18/2009
Last Update Date	:	03/16/2012

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