MEDICARE: DR. ASHOK PANDURANGA DEVATHA M.D.

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	207Q00000X	Family Medicine Physician	35-07-3686 D	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	:	1497740328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHOK PANDURANGA DEVATHA M.D.

Provider Business Mailing Address
First Line	:	432 N MAIN ST
Second Line	:
City	:	NEW CARLISLE
State	:	OH
Zip	:	45344-1427
Country	:	US
Telephone Number	:	937-846-4000
Fax Number	:	937-846-4004

Provider Business Practice Location Address
First Line	:	432 N MAIN ST
Second Line	:
City	:	NEW CARLISLE
State	:	OH
Zip	:	45344-1427
Country	:	US
Telephone Number	:	937-846-4000
Fax Number	:	937-846-4004

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	09/22/2010

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