Provider Demographics
NPI:1326142803
Name:BHADRA, EVA L (MD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:L
Last Name:BHADRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13241 RAVENNA ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024
Mailing Address - Country:US
Mailing Address - Phone:440-285-9166
Mailing Address - Fax:440-285-1806
Practice Address - Street 1:13241 RAVENNA ROAD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024
Practice Address - Country:US
Practice Address - Phone:440-285-9166
Practice Address - Fax:440-285-1806
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069440208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2036529Medicaid
OH2036529Medicaid