Provider Demographics
NPI:1841561677
Name:KRISHNA M RAGOTHAMAN MD INC
Entity type:Organization
Organization Name:KRISHNA M RAGOTHAMAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAGOTHAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-898-8124
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:43449-0415
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068996 R261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01816465Medicaid
OH01816465Medicaid
OHF43800Medicare UPIN