Basic Information
Provider Information | |||||||||
NPI: | 1376706846 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GANDHI | ||||||||
FirstName: | ROOPA | ||||||||
MiddleName: | DHAWAN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DHAWAN | ||||||||
OtherFirstName: | ROOPA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2925 VERNON PL STE 100 | ||||||||
Address2: |   | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 452192425 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5137516667 | ||||||||
FaxNumber: | 5138724553 | ||||||||
Practice Location | |||||||||
Address1: | 11059 GRANDSTONE LN | ||||||||
Address2: |   | ||||||||
City: | MONTGOMERY | ||||||||
State: | OH | ||||||||
PostalCode: | 452493418 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5137516667 | ||||||||
FaxNumber: | 5138724553 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/05/2008 | ||||||||
LastUpdateDate: | 11/24/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | BP10031165 | TX | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 35.097528 | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.