Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 35074317S | OH |
Y | 207QA0505X | Family Doctor - Adult Medicine | 35074317S | OH |
NPI | 1104912773 |
---|---|
Provider Name | Ramalingam Selvarajah |
First Address | London, OH 43140-1161 |
Second Address | London, OH 43140-1161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 02/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2064420 | (05) | OH |
G64465 | (02) | OH |
P00018116 | RAILROAD MEDICARE (01) | OH |