Provider Demographics
NPI:1003816687
Name:OZA, RATNAM A (MD)
Entity Type:Individual
Prefix:
First Name:RATNAM
Middle Name:A
Last Name:OZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S MAIN ST
Mailing Address - Street 2:STE. 203
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2682
Mailing Address - Country:US
Mailing Address - Phone:937-222-0603
Mailing Address - Fax:937-222-7122
Practice Address - Street 1:1100 S MAIN ST
Practice Address - Street 2:STE. 203
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2682
Practice Address - Country:US
Practice Address - Phone:937-222-0603
Practice Address - Fax:937-222-7122
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044276207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000281449OtherANTHEM
OH0498304Medicaid
OH0498304Medicaid