Provider Demographics
NPI:1164493052
Name:RAVICHANDRAN, RAMACHANDRAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMACHANDRAN
Middle Name:C
Last Name:RAVICHANDRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAM
Other - Middle Name:C
Other - Last Name:RAVI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:29325 HEALTH CAMPUS DR STE 3
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-8201
Mailing Address - Country:US
Mailing Address - Phone:440-414-9400
Mailing Address - Fax:216-201-5591
Practice Address - Street 1:29325 HEALTH CAMPUS DR STE 3
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-8201
Practice Address - Country:US
Practice Address - Phone:440-414-9400
Practice Address - Fax:216-201-5591
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069332207R00000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110194567OtherRAILROAD MEDICARE
OH000000128708OtherANTHEM
OH9379701OtherGROUP MEDICARE PTAN
OHF69332OtherSUMMA
OH0350043Medicaid
OHP01430000OtherMEDICARE RAILROAD INDIVIDUAL PTAN
OHDO6570OtherMEDICARE RAILROAD GROUP PTAN
OH0350043Medicaid
OHH367170Medicare PIN