Basic Information
| Provider Information | |||||||||
| NPI: | 1427024116 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DASARI | ||||||||
| FirstName: | NARAYANA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20525 CENTER RIDGE ROAD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | ROCKY RIVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408955056 | ||||||||
| FaxNumber: | 4403332935 | ||||||||
| Practice Location | |||||||||
| Address1: | 25200 CENTER RIDGE ROAD | ||||||||
| Address2: | # 2600 | ||||||||
| City: | WESTLAKE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403333904 | ||||||||
| FaxNumber: | 4403319531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 05/27/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35 04 1228 D | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000198484 | 01 | ANTHEM | OTHER | 1780634279 | 01 | GROUP NPI | OTHER | 4007139 | 01 | OH | AETNA | OTHER | D368301 | 01 | OH | DIAGNOSTIC GROUP MEDICARE | OTHER | 0119204 | 01 | GROUP MEDICAID | OTHER | 0404995 | 05 | OH | MEDICAID | 9273172 | 01 | OH | GROUP MEDICARE | OTHER | 102297 | 01 | KAISER | OTHER | 3610861 | 01 | OH | ASC GROUP MEDICARE | OTHER | F41228 | 01 | SUMMACARE APEX | OTHER | CA4511 | 01 | RR MEDICARE GROUP | OTHER | 110177994 | 01 | OH | RAILROAD MEDICARE | OTHER | 341783789040 | 01 | CARESOURCE | OTHER |