Provider Demographics
NPI:1285655324
Name:BIDARI, TIMMAPPA PANDAPPA (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMMAPPA
Middle Name:PANDAPPA
Last Name:BIDARI
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 1:6820 RIDGE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5646
Mailing Address - Country:US
Mailing Address - Phone:440-887-9570
Mailing Address - Fax:440-887-9572
Practice Address - Street 1:6820 RIDGE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5646
Practice Address - Country:US
Practice Address - Phone:440-887-9570
Practice Address - Fax:440-887-9572
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35036806B174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000165156OtherANTHEM BC/BS
OH0262513Medicaid
OHBI0398791Medicare ID - Type Unspecified
OH0262513Medicaid