Provider Demographics
NPI:1770674947
Name:RAMAIAH, PRIYABALA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRIYABALA
Middle Name:
Last Name:RAMAIAH
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 1:1445 HARRISON AVE NW
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2620
Mailing Address - Country:US
Mailing Address - Phone:330-452-9900
Mailing Address - Fax:330-452-9945
Practice Address - Street 1:1445 HARRISON AVE NW
Practice Address - Street 2:SUITE 302
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2620
Practice Address - Country:US
Practice Address - Phone:330-452-9900
Practice Address - Fax:330-452-9945
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064484R207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0925388Medicaid
OH9324291Medicare ID - Type UnspecifiedCANTON GROUP #
OHF59317Medicare UPIN
OH0925388Medicaid