MEDICARE: SWARNALATHA MEYYAZHAGAN 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	35-079277	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110244463	OTHER		MCR RR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841216462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SWARNALATHA MEYYAZHAGAN MD

Provider Business Mailing Address
First Line	:	20525 CENTER RIDGE RD
Second Line	:	SUITE 220
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-3437
Country	:	US
Telephone Number	:	440-895-5042
Fax Number	:	440-333-2935

Provider Business Practice Location Address
First Line	:	807 WEST AVE
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-5898
Country	:	US
Telephone Number	:	440-284-9487
Fax Number	:	440-284-9378

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

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	02/26/2009

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