Provider Demographics
NPI:1184602138
Name:NARRA, BHASKARA R (MD)
Entity type:Individual
Prefix:
First Name:BHASKARA
Middle Name:R
Last Name:NARRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:ELMORE
Mailing Address - State:OH
Mailing Address - Zip Code:43416-0067
Mailing Address - Country:US
Mailing Address - Phone:419-862-2916
Mailing Address - Fax:419-862-1701
Practice Address - Street 1:3105 S STATE ROUTE 51
Practice Address - Street 2:
Practice Address - City:ELMORE
Practice Address - State:OH
Practice Address - Zip Code:43416-9625
Practice Address - Country:US
Practice Address - Phone:419-862-2916
Practice Address - Fax:419-862-1701
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35037046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0290288Medicaid
OH0290288Medicaid
A75116Medicare UPIN