Provider Demographics
NPI:1306820063
Name:KANODIA, ANUP K (MD, MPH)
Entity Type:Individual
Prefix:
First Name:ANUP
Middle Name:K
Last Name:KANODIA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 KENNY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3502
Mailing Address - Country:US
Mailing Address - Phone:614-293-9777
Mailing Address - Fax:614-293-9776
Practice Address - Street 1:2000 KENNY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:614-293-9777
Practice Address - Fax:614-293-9776
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34347207Q00000X
MA228350207Q00000X
OH35.094212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2987120Medicaid
OHKA4273611Medicare PIN