Provider Demographics
NPI:1477813392
Name:RAHUNANTHAN, NIRANSHINY
Entity Type:Individual
Prefix:
First Name:NIRANSHINY
Middle Name:
Last Name:RAHUNANTHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIRANSHINY
Other - Middle Name:
Other - Last Name:PARAMESWARAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3535 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1221
Mailing Address - Country:US
Mailing Address - Phone:937-395-6665
Mailing Address - Fax:937-522-9260
Practice Address - Street 1:3535 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1221
Practice Address - Country:US
Practice Address - Phone:937-395-6665
Practice Address - Fax:937-522-9260
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.126078208M00000X
390200000X
OH35126078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0124726Medicaid
OH0124726Medicaid