Provider Demographics
NPI:1881720746
Name:DESAI G. KRISHNA-RAO
Entity type:Organization
Organization Name:DESAI G. KRISHNA-RAO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DESAI
Authorized Official - Middle Name:GOPALA
Authorized Official - Last Name:KRISHNA-RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-726-6673
Mailing Address - Street 1:827 MCKAY CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5790
Mailing Address - Country:US
Mailing Address - Phone:330-726-6673
Mailing Address - Fax:330-726-6673
Practice Address - Street 1:827 MCKAY CT
Practice Address - Street 2:SUITE C
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5790
Practice Address - Country:US
Practice Address - Phone:330-726-6673
Practice Address - Fax:330-726-6673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044964K174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0439145Medicaid
OHKR0480442Medicare ID - Type Unspecified
OH0439145Medicaid