Individual
KANCHERLA RAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6140 S BROADWAY, LORAIN, OH 44053-3821
(440) 204-4364
(440) 233-9070
Mailing address
11124 WOODBURY LANE, ELYRIA, OH 44035
(440) 877-1859
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
35046832
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0069823
—
OH
Enumeration date
02/07/2007
Last updated
02/19/2013
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