Provider Demographics
NPI:1043275076
Name:NATESAN, MALARVIZHI (MS AA)
Entity Type:Individual
Prefix:
First Name:MALARVIZHI
Middle Name:
Last Name:NATESAN
Suffix:
Gender:F
Credentials:MS AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 ACKERMAN 3RD FLOOR
Mailing Address - Street 2:PO BOX 183103
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-3103
Mailing Address - Country:US
Mailing Address - Phone:614-293-2150
Mailing Address - Fax:614-293-6479
Practice Address - Street 1:410 WEST TENTH AVE
Practice Address - Street 2:N429 DOAN HALL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-293-4705
Practice Address - Fax:614-293-8153
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67000044367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2269503Medicaid
NA8222413Medicare ID - Type Unspecified
OH2269503Medicaid