Basic Information
| Provider Information | |||||||||
| NPI: | 1801959663 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAYTON DIGESTIVE CONSULTANTS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 634869 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452630042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007422368 | ||||||||
| FaxNumber: | 9372912962 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 N PROGRESS DR | ||||||||
| Address2: | |||||||||
| City: | XENIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453852666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373724384 | ||||||||
| FaxNumber: | 9373723946 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 08/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | ORUGANTI | ||||||||
| AuthorizedOfficialFirstName: | NAGARAJA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9375347330 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | DD6894 | 01 | OH | RAILROAD MEDICARE | OTHER |