Provider Demographics
NPI:1912160268
Name:LINGAM, PRASANTH (MD)
Entity Type:Individual
Prefix:
First Name:PRASANTH
Middle Name:
Last Name:LINGAM
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 1:1010 CEREAL AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-2784
Mailing Address - Country:US
Mailing Address - Phone:513-867-3331
Mailing Address - Fax:513-867-2667
Practice Address - Street 1:1010 CEREAL AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2784
Practice Address - Country:US
Practice Address - Phone:513-867-3331
Practice Address - Fax:513-867-2667
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-052051207R00000X
OH35121968207RC0000X
OH35.121968207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0089392Medicaid
OHH242180Medicare PIN
OHH242181Medicare PIN