Provider Demographics
NPI:1295738235
Name:RAGOTHAMAN, KRISHNA M (MD)
Entity type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:M
Last Name:RAGOTHAMAN
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 1:128 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:43449-1358
Mailing Address - Country:US
Mailing Address - Phone:419-898-8124
Mailing Address - Fax:419-898-9148
Practice Address - Street 1:128 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:OH
Practice Address - Zip Code:43449-1358
Practice Address - Country:US
Practice Address - Phone:419-898-8124
Practice Address - Fax:419-898-9148
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0181646Medicaid
OHFA0791225Medicare PIN
OHRA0791223Medicare PIN
OH0181646Medicaid