Provider Demographics
NPI:1336176882
Name:RAMANATHAN, VIDYA K (MD)
Entity Type:Individual
Prefix:
First Name:VIDYA
Middle Name:K
Last Name:RAMANATHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:ONE SEAGATE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-824-7451
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:1601 BRIGHAM DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7114
Practice Address - Country:US
Practice Address - Phone:419-872-7700
Practice Address - Fax:419-874-0196
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-093203208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104768362Medicaid
OH0068764Medicaid
MIVK085434OtherBLUE SHIELD
MI104768362Medicaid