Provider Demographics
NPI:1841279510
Name:DACHA, HARINATHRAO R (MD)
Entity type:Individual
Prefix:
First Name:HARINATHRAO
Middle Name:R
Last Name:DACHA
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 1:125 E BROAD ST
Mailing Address - Street 2:SUITE 119
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6400
Mailing Address - Country:US
Mailing Address - Phone:440-329-7397
Mailing Address - Fax:440-329-7396
Practice Address - Street 1:125 E BROAD ST
Practice Address - Street 2:SUITE 119
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6400
Practice Address - Country:US
Practice Address - Phone:440-329-7397
Practice Address - Fax:440-329-7396
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3546450D174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0464895Medicaid
OH0498074Medicare PIN