Provider Demographics
NPI:1093150674
Name:TEWARI, ANURAG (MD)
Entity Type:Individual
Prefix:DR
First Name:ANURAG
Middle Name:
Last Name:TEWARI
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 1:435 OLD WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45065-8812
Mailing Address - Country:US
Mailing Address - Phone:319-248-5549
Mailing Address - Fax:
Practice Address - Street 1:8118 CORPORATE WAY STE 212
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9560
Practice Address - Country:US
Practice Address - Phone:484-351-8459
Practice Address - Fax:484-351-8810
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1273862084N0600X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty