Provider Demographics
NPI:1801894910
Name:KESARIA, ASHWIN C (MD)
Entity type:Individual
Prefix:
First Name:ASHWIN
Middle Name:C
Last Name:KESARIA
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 1:3116 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5483
Mailing Address - Country:US
Mailing Address - Phone:419-627-1830
Mailing Address - Fax:
Practice Address - Street 1:3116 STONEWOOD DR
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5483
Practice Address - Country:US
Practice Address - Phone:419-627-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350471812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0785235Medicaid
OHKE0524422Medicare ID - Type Unspecified
OH0785235Medicaid
OHKE0524423Medicare PIN