Basic Information
| Provider Information | |||||||||
| NPI: | 1134185473 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARTHASARATHI | ||||||||
| FirstName: | NIRANJANA | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CANDADAI | ||||||||
| OtherFirstName: | NIRANJANA | ||||||||
| OtherMiddleName: | PARTHASARATHI | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | CLOVERDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954253204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7076691806 | ||||||||
| FaxNumber: | 7078947820 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 TARMAN DR | ||||||||
| Address2: | |||||||||
| City: | CLOVERDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954253932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078944229 | ||||||||
| FaxNumber: | 7078942954 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 05/17/2016 | ||||||||
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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 | 207R00000X | 35062696C | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | G133895 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64932841 | 05 | KY | MEDICAID | 0927411 | 05 | OH | MEDICAID | 200037900 | 05 | IN | MEDICAID |