Basic Information
| Provider Information | |||||||||
| NPI: | 1124084850 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMBHATLA | ||||||||
| FirstName: | RAJYALAKSHMI | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1740 CLEVELAND RD | ||||||||
| Address2: | |||||||||
| City: | WOOSTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446912204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302874500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1740 CLEVELAND RD | ||||||||
| Address2: | |||||||||
| City: | WOOSTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446912204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302874800 | ||||||||
| FaxNumber: | 3302640167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 11/29/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35072657 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | 35072657 | OH | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 2020646 | 05 | OH | MEDICAID |