Individual
DR. SURESH VADADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
661 S TRIMBLE RD, MANSFIELD, OH 44906-3437
(419) 774-0478
(419) 774-9887
Mailing address
661 S TRIMBLE RD, MANSFIELD, OH 44906-3437
(419) 774-0478
(419) 774-9887
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
35074411V
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0114549
GROUP MEDICAID
OH
05
—
2072215
—
OH
01
—
KI9260531
GROUP MEDICARE
OH
Enumeration date
06/28/2005
Last updated
02/01/2012
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