Provider Demographics
NPI:1164479200
Name:BAISHNAB, RADHA R (MD)
Entity Type:Individual
Prefix:DR
First Name:RADHA
Middle Name:R
Last Name:BAISHNAB
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 1:7901 DETROIT AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-2828
Mailing Address - Country:US
Mailing Address - Phone:216-961-8100
Mailing Address - Fax:216-961-7883
Practice Address - Street 1:7901 DETROIT AVE STE 340
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-2828
Practice Address - Country:US
Practice Address - Phone:216-961-8100
Practice Address - Fax:216-961-7883
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35032255B207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2026935Medicaid
OH000000538601OtherANTHEM BC/BS
OH000000387103OtherANTHEM BC/BS
OH341542312098OtherCARESOURCE
OHP00448228OtherRAILROAD CARE
OH0173164Medicaid
OH340714684101OtherCARESOURCE
OHP00437214OtherRAILROAD CARE
OHP00437214OtherRAILROAD CARE
OH340714684101OtherCARESOURCE
OH000000387103OtherANTHEM BC/BS
OHP00448228OtherRAILROAD CARE
OH4179737Medicare PIN