Provider Demographics
NPI:1134185473
Name:PARTHASARATHI, NIRANJANA (MD)
Entity type:Individual
Prefix:
First Name:NIRANJANA
Middle Name:
Last Name:PARTHASARATHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIRANJANA
Other - Middle Name:PARTHASARATHI
Other - Last Name:CANDADAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95425-3204
Mailing Address - Country:US
Mailing Address - Phone:707-669-1806
Mailing Address - Fax:707-894-7820
Practice Address - Street 1:6 TARMAN DR
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:CA
Practice Address - Zip Code:95425-3932
Practice Address - Country:US
Practice Address - Phone:707-894-4229
Practice Address - Fax:707-894-2954
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062696C207R00000X
CAG133895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64932841Medicaid
OH0927411Medicaid
IN200037900Medicaid
KY64932841Medicaid
OHCA0705246Medicare PIN
F16973Medicare UPIN