Provider Demographics
NPI:1922073956
Name:KEDIA, ANURAG WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:ANURAG
Middle Name:WILLIAM
Last Name:KEDIA
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 1:33 NORTH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1925
Mailing Address - Country:US
Mailing Address - Phone:330-633-3883
Mailing Address - Fax:330-633-6658
Practice Address - Street 1:33 NORTH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1925
Practice Address - Country:US
Practice Address - Phone:330-633-3883
Practice Address - Fax:330-633-6658
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-0073-K207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000320285OtherUNICARE - LIFE & HEALTH
729961OtherBUCKEYE COMMUNITY HEALTH
000000181145OtherTHREE RIVERS HEALTH PLANS
OH2345500Medicaid
000000320285OtherANTHEM
Q009759OtherHOMETOWN HEALTH NETWORK
695OtherSUMMACARE HEALTH PLAN
Q009759OtherHOMETOWN HEALTH NETWORK
729961OtherBUCKEYE COMMUNITY HEALTH
OH4072055Medicare PIN