Provider Demographics
NPI:1780612333
Name:NAGAJOTHI, NAGAPRASAD (MD)
Entity type:Individual
Prefix:
First Name:NAGAPRASAD
Middle Name:
Last Name:NAGAJOTHI
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 36660
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44735-6660
Mailing Address - Country:US
Mailing Address - Phone:330-478-0001
Mailing Address - Fax:330-478-0004
Practice Address - Street 1:7337 CARITAS CIR NW STE 150
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-9128
Practice Address - Country:US
Practice Address - Phone:330-478-0001
Practice Address - Fax:330-837-2646
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086648207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2044639Medicaid
OH000000476584OtherANTHEM BC/BS