Provider Demographics
NPI:1023064433
Name:KALAHASTHY, ANNADORAI (MD)
Entity type:Individual
Prefix:
First Name:ANNADORAI
Middle Name:
Last Name:KALAHASTHY
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 1:6251 MIAMI VALLEY WAY
Mailing Address - Street 2:SUITE 210A
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424
Mailing Address - Country:US
Mailing Address - Phone:937-233-2009
Mailing Address - Fax:937-233-9182
Practice Address - Street 1:6251 GOOD SAMARITAN WAY
Practice Address - Street 2:SUITE 210 A
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1051
Practice Address - Country:US
Practice Address - Phone:937-233-2009
Practice Address - Fax:937-233-8389
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.074814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2108883Medicaid
OH0870132Medicare PIN
OH0870133Medicare PIN
OH2108883Medicaid