Provider Demographics
NPI:1841216462
Name:MEYYAZHAGAN, SWARNALATHA (MD)
Entity Type:Individual
Prefix:
First Name:SWARNALATHA
Middle Name:
Last Name:MEYYAZHAGAN
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 1:20525 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3437
Mailing Address - Country:US
Mailing Address - Phone:440-895-5042
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:807 WEST AVE
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-5898
Practice Address - Country:US
Practice Address - Phone:440-284-9487
Practice Address - Fax:440-284-9378
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-079277207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110244463OtherMCR RR
OH2357300Medicaid
OH2357300Medicaid
H74261Medicare UPIN