Basic Information
| Provider Information | |||||||||
| NPI: | 1457371676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NARASIMHAN | ||||||||
| FirstName: | SUMANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SUNDARARAJAN | ||||||||
| OtherFirstName: | SUMANA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9500 EUCLID AVE # R3 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164455158 | ||||||||
| FaxNumber: | 2166366761 | ||||||||
| Practice Location | |||||||||
| Address1: | 9500 EUCLID AVE # R3 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441951716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164455158 | ||||||||
| FaxNumber: | 2166366761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 11/11/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35080687 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0205X | 35-080687 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 000000221013 | 01 | OH | UNISON | OTHER | 364066 | 01 | OH | WELLCARE | OTHER | 745974 | 01 | OH | BUCKEYE | OTHER | 2468088 | 01 | OH | AETNA | OTHER | 256785 | 01 | OH | BCMH | OTHER | 000000526137 | 01 | OH | ANTHEM | OTHER | 1018654360001 | 01 | OH | PA MEDICAID | OTHER | 000000370630 | 01 | OH | ANTHEM | OTHER | 2562785 | 05 | OH | MEDICAID |