Provider Demographics
NPI:1386634681
Name:TALIWAL, RUCHI (MD)
Entity Type:Individual
Prefix:
First Name:RUCHI
Middle Name:
Last Name:TALIWAL
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 1:3800 EMBASSY PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-8409
Mailing Address - Country:US
Mailing Address - Phone:330-666-4158
Mailing Address - Fax:330-668-2256
Practice Address - Street 1:3800 EMBASSY PKWY STE 230
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-8409
Practice Address - Country:US
Practice Address - Phone:330-666-4158
Practice Address - Fax:330-668-2256
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2514345Medicaid
OH2514345Medicaid
OH2514345Medicaid