Individual
PANCHARATHNA K ATHMARAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
661 PARK AVE E, SUITE A, MANSFIELD, OH 44905-2880
(419) 526-3999
(419) 526-1137
Mailing address
661 PARK AVE E, SUITE A, MANSFIELD, OH 44905-2880
(419) 526-3999
(419) 526-1137
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35051805
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0585424
—
OH
01
—
110188865
RAILROAD MEDICARE
—
Enumeration date
09/06/2005
Last updated
10/21/2009
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