Provider Demographics
NPI:1376564849
Name:MOORTHY, PALANIVEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:PALANIVEL
Middle Name:G
Last Name:MOORTHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 643273
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-0307
Mailing Address - Country:US
Mailing Address - Phone:513-891-2813
Mailing Address - Fax:513-793-1032
Practice Address - Street 1:311 NILLES RD
Practice Address - Street 2:STE G
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2636
Practice Address - Country:US
Practice Address - Phone:513-858-6555
Practice Address - Fax:513-858-6222
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0426522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00062550OtherRR MEDICARE
OH0408973Medicaid
A79050Medicare UPIN
OH0469193Medicare PIN