Provider Demographics
NPI:1457433831
Name:KALVAKOTA, SHARAT C (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARAT
Middle Name:C
Last Name:KALVAKOTA
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 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8068
Practice Address - Street 1:4000 MIAMISBURG CENTERVILLE RD STE 450
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3908
Practice Address - Country:US
Practice Address - Phone:937-560-2011
Practice Address - Fax:937-562-2012
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045600208800000X
OH35-04-5600208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0450284Medicaid
OH0450284Medicaid
OH0490444Medicare PIN
OHKA0490444Medicare PIN