Provider Demographics
NPI:1255316204
Name:TALLAM, JANARDAN R (MD)
Entity Type:Individual
Prefix:MR
First Name:JANARDAN
Middle Name:R
Last Name:TALLAM
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 1:5700 DARROW RD
Mailing Address - Street 2:STE 106
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5021
Mailing Address - Country:US
Mailing Address - Phone:330-656-5911
Mailing Address - Fax:330-656-5901
Practice Address - Street 1:1044 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1006
Practice Address - Country:US
Practice Address - Phone:330-746-7211
Practice Address - Fax:330-480-3916
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052347T207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0602708Medicaid
OH001000622-0001OtherPENNSYLVANIA MEDICAID
OHP00360142OtherRAILROAD MEDICARE
OHTA0659825Medicare PIN
C34534Medicare UPIN
OHP00360142OtherRAILROAD MEDICARE
OHTA0659824Medicare PIN