Provider Demographics
NPI:1023212917
Name:RAGHUNATHAN, KALPANA (MD)
Entity Type:Individual
Prefix:
First Name:KALPANA
Middle Name:
Last Name:RAGHUNATHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 S MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-2218
Mailing Address - Country:US
Mailing Address - Phone:330-684-1300
Mailing Address - Fax:330-682-0565
Practice Address - Street 1:830 S MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-2218
Practice Address - Country:US
Practice Address - Phone:330-684-1300
Practice Address - Fax:330-682-0565
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35096140207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism