Provider Demographics
NPI:1164496840
Name:NADARAJAH, RAVINDRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVINDRAN
Middle Name:
Last Name:NADARAJAH
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 1:110 DANIEL DR STE 14
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8002
Mailing Address - Country:US
Mailing Address - Phone:724-430-0310
Mailing Address - Fax:724-430-0314
Practice Address - Street 1:110 DANIEL DR STE 14
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8002
Practice Address - Country:US
Practice Address - Phone:724-430-0310
Practice Address - Fax:724-430-0314
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073018L207YX0602X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA926365OtherBLUE CROSS
PA0018430980003Medicaid
PAH39223Medicare UPIN
PA047727R6LMedicare PIN
PA0018430980003Medicaid
PA047727EN4Medicare ID - Type Unspecified