Provider Demographics
NPI:1013616176
Name:GHIMIRE, CHUDAMANI
Entity Type:Individual
Prefix:
First Name:CHUDAMANI
Middle Name:
Last Name:GHIMIRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4978 ETON CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-6876
Mailing Address - Country:US
Mailing Address - Phone:267-250-1652
Mailing Address - Fax:
Practice Address - Street 1:4978 ETON CT
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-6876
Practice Address - Country:US
Practice Address - Phone:267-250-1652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH202106102528343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)