Provider Demographics
NPI:1114923646
Name:SRIKANTIAH, A R (MD)
Entity Type:Individual
Prefix:
First Name:A
Middle Name:R
Last Name:SRIKANTIAH
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 1:9884 CADIZ RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9633
Mailing Address - Country:US
Mailing Address - Phone:740-432-7319
Mailing Address - Fax:740-432-7310
Practice Address - Street 1:9884 CADIZ RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9633
Practice Address - Country:US
Practice Address - Phone:740-432-7319
Practice Address - Fax:740-432-7310
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040065S207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0316518Medicaid
000000118077OtherANTHEM
000000118077OtherANTHEM
OH0316518Medicaid