Basic Information
| Provider Information | |||||||||
| NPI: | 1205147030 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NARAYANAN | ||||||||
| FirstName: | RAGAVAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3533 SOUTHERN BLVD STE 2100 | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454291267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373958556 | ||||||||
| FaxNumber: | 9375227873 | ||||||||
| Practice Location | |||||||||
| Address1: | 3533 SOUTHERN BLVD | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454291264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373958556 | ||||||||
| FaxNumber: | 9375227873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2010 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 244152 | MA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 35.129282 | OH | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 036137737 | IL | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | 35.129282 | OH | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0179049 | 05 | OH | MEDICAID |