Basic Information
| Provider Information | |||||||||
| NPI: | 1437195229 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | R DONTHI MD & ASSOC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 GRAHAM RD | ||||||||
| Address2: | STE #2 | ||||||||
| City: | CUYAHOGA FALLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442232259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309235123 | ||||||||
| FaxNumber: | 3309236654 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 GRAHAM RD | ||||||||
| Address2: | STE #2 | ||||||||
| City: | CUYAHOGA FALLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442232259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309235123 | ||||||||
| FaxNumber: | 3309236654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 04/30/2010 | ||||||||
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| AuthorizedOfficialLastName: | DONTHI | ||||||||
| AuthorizedOfficialFirstName: | KIRAN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3309235123 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0475972 | 05 | OH | MEDICAID | D00482542 | 01 | MEDICARE PIN | OTHER | 0417454 | 05 | OH | MEDICAID |