Provider Demographics
NPI:1982656005
Name:KANTHARAJ, BELAGODU N (MD)
Entity Type:Individual
Prefix:DR
First Name:BELAGODU
Middle Name:N
Last Name:KANTHARAJ
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 1:36446 N RESERVE CIR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2820
Mailing Address - Country:US
Mailing Address - Phone:440-823-5966
Mailing Address - Fax:
Practice Address - Street 1:41201 SCHADDEN ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2220
Practice Address - Country:US
Practice Address - Phone:440-324-0401
Practice Address - Fax:440-324-0405
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH46026207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH045367Medicaid
OH341832420029OtherCARESOURCE
OH50947OtherQUAL CHOICE
OHE46046OtherSUMMACARE
OH830002969OtherRAILROAD MEDICARE
OH3000075OtherUNITED HEALTHCARE
OH15615OtherOHIO HEALTH CHOICE
OH000000139923OtherANTHEM
OH3000075OtherUNITED HEALTHCARE