Provider Demographics
NPI:1851713879
Name:METLA, SRAVAN KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SRAVAN KUMAR
Middle Name:
Last Name:METLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 CANNONBURY CT
Mailing Address - Street 2:APT 1
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-8110
Mailing Address - Country:US
Mailing Address - Phone:347-255-7914
Mailing Address - Fax:
Practice Address - Street 1:33 W RAHN RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2219
Practice Address - Country:US
Practice Address - Phone:937-433-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.123313207R00000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH320390Medicaid
OH0103414Medicaid