Provider Demographics
NPI:1538342886
Name:PATABI RAJ SEETHARAMAN MD
Entity type:Organization
Organization Name:PATABI RAJ SEETHARAMAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATABI
Authorized Official - Middle Name:RAJ
Authorized Official - Last Name:SEETHARAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-998-3198
Mailing Address - Street 1:4043 IRVING PL APT 109
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2964
Mailing Address - Country:US
Mailing Address - Phone:330-998-3198
Mailing Address - Fax:
Practice Address - Street 1:4043 IRVING PL APT 109
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2964
Practice Address - Country:US
Practice Address - Phone:330-998-3198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2023-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057803207W00000X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCM1431OtherMEDICARE ID TYPE UNSPECIFIED
OH0897374Medicaid
9287993OtherMEDICARE GROUP
OH0897374Medicaid
9287993OtherMEDICARE GROUP