Provider Demographics
NPI:1205147030
Name:NARAYANAN, RAGAVAN (MD)
Entity type:Individual
Prefix:
First Name:RAGAVAN
Middle Name:
Last Name:NARAYANAN
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 1:3533 SOUTHERN BLVD STE 2100
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1267
Mailing Address - Country:US
Mailing Address - Phone:937-395-8556
Mailing Address - Fax:937-522-7873
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:SUITE 2100
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1264
Practice Address - Country:US
Practice Address - Phone:937-395-8556
Practice Address - Fax:937-522-7873
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-26
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA244152208600000X
OH35.129282208600000X, 2086S0102X
IL0361377372086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0179049Medicaid
OH0179049Medicaid