Provider Demographics
NPI:1538152848
Name:SHANKARAN, USHA (MD)
Entity type:Individual
Prefix:DR
First Name:USHA
Middle Name:
Last Name:SHANKARAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19250 BAGLEY RD
Mailing Address - Street 2:#101
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3314
Mailing Address - Country:US
Mailing Address - Phone:440-891-8800
Mailing Address - Fax:440-891-1734
Practice Address - Street 1:19250 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3314
Practice Address - Country:US
Practice Address - Phone:440-826-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-037849207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311533239030OtherCARESOURCE
OH000000121447OtherANTHEM BCBS
OH050056450OtherRAILROAD MEDICARE
OH0607980Medicaid
OH311533239030OtherCARESOURCE
OHSH0417425Medicare ID - Type Unspecified