Provider Demographics
NPI:1285672642
Name:SUNDARARAJAN, KRISHNAN (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNAN
Middle Name:
Last Name:SUNDARARAJAN
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 1:100 SEVENTH AVE
Mailing Address - Street 2:STE 222
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1067
Mailing Address - Country:US
Mailing Address - Phone:440-350-9740
Mailing Address - Fax:
Practice Address - Street 1:100 7TH AVE
Practice Address - Street 2:STE 222
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-7804
Practice Address - Country:US
Practice Address - Phone:440-285-2300
Practice Address - Fax:440-285-2320
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065450207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0959575Medicaid
OH0754323Medicare PIN
OH0959575Medicaid
OHP00142990Medicare PIN