MEDICARE: NEW CARLISLE FAMILY PRACTICE LLC

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	35073686D	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	:	1699891085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW CARLISLE FAMILY PRACTICE LLC

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	:	PHYSICIAN
Name	:	ASHOK P DEVATHA
Credential	:	M.D.
Telephone Number	:	937-846-4000

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	04/04/2014

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Directions to “NEW CARLISLE FAMILY PRACTICE LLC ” Practice Location

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