Basic Information
Provider Information
NPI: 1003018425
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LINGADEVARU
FirstName: HEMANTH
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: MD,MPH,FAAP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 CHILDRENS PLZ
Address2:  
City: DAYTON
State: OH
PostalCode: 454041815
CountryCode: US
TelephoneNumber: 9376413000
FaxNumber:  
Practice Location
Address1: 1 CHILDRENS PLZ
Address2:  
City: DAYTON
State: OH
PostalCode: 454041815
CountryCode: US
TelephoneNumber: 9376413000
FaxNumber: 9376413107
Other Information
ProviderEnumerationDate: 06/05/2007
LastUpdateDate: 12/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/22/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0203X35.096351OHY Allopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine

ID Information
IDTypeStateIssuerDescription
311568605OH MEDICAID


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