Provider Demographics
NPI:1952361701
Name:JOHN NIRMALNATH MD
Entity Type:Organization
Organization Name:JOHN NIRMALNATH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIRMALNATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-525-2241
Mailing Address - Street 1:295 GLESSNER AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903
Mailing Address - Country:US
Mailing Address - Phone:419-525-2241
Mailing Address - Fax:419-525-1092
Practice Address - Street 1:295 GLESSNER AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903
Practice Address - Country:US
Practice Address - Phone:419-525-2241
Practice Address - Fax:419-525-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3506759207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH019311Medicaid
OH06476736900OtherBLUE
OH000000121141OtherANTHEM
0792143Medicare PIN
OH06476736900OtherBLUE