Provider Demographics
NPI:1497783500
Name:TANDRA, USHARANI V (MD)
Entity Type:Individual
Prefix:
First Name:USHARANI
Middle Name:V
Last Name:TANDRA
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 1:1610 MENTOR AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:PAINSEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1745
Mailing Address - Country:US
Mailing Address - Phone:440-352-6132
Mailing Address - Fax:440-392-6193
Practice Address - Street 1:18697 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3497
Practice Address - Country:US
Practice Address - Phone:216-778-3119
Practice Address - Fax:208-977-9077
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074966208100000X
OH35-074966208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5072204300OtherBWC
OH2118587Medicaid
OHTA7276341Medicare ID - Type Unspecified
7276341Medicare PIN
G92083Medicare UPIN
OHG92083Medicare UPIN