Provider Demographics
NPI:1598882904
Name:NORTHSTAR FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:NORTHSTAR FAMILY PRACTICE INC
Other - Org Name:NORTHTOWNE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJESWARI
Authorized Official - Middle Name:A
Authorized Official - Last Name:LINGAMNENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-888-2450
Mailing Address - Street 1:5910 CLEVELAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231
Mailing Address - Country:US
Mailing Address - Phone:614-888-2450
Mailing Address - Fax:
Practice Address - Street 1:5910 CLEVELAND AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231
Practice Address - Country:US
Practice Address - Phone:614-888-2450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078171207Q00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2273098Medicaid
OH=========00OtherBWC
OH2273098Medicaid
OHH54191Medicare UPIN