Provider Demographics
NPI:1730130626
Name:MISRA, LALITH K (DO PHD)
Entity Type:Individual
Prefix:
First Name:LALITH
Middle Name:K
Last Name:MISRA
Suffix:
Gender:M
Credentials:DO PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:# L-3652
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-6453
Mailing Address - Country:US
Mailing Address - Phone:740-383-7927
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:990 S PROSPECT ST STE 3
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6283
Practice Address - Country:US
Practice Address - Phone:740-383-7910
Practice Address - Fax:740-375-8129
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0074512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
2056793OtherCIGNA
OH2205885Medicaid
353077OtherSUBMITTER NO
260782000OtherMAGELLAN MIS
311098079OtherTAX ID
OH000000206898OtherANTHEM
260047857OtherTRAVELERS MEDICARE
260782000OtherAETNA
311098079OtherPPO NEXT
320201OtherMT CARMEL BEHAVIORAL HEAL
1555037OtherUHC
260782000OtherAETNA
260047857OtherTRAVELERS MEDICARE
H32673Medicare UPIN