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Individual

GEETHA C AMBALAVANAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
2180 GATEWAY DR, FAIRBORN, OH 45324-6356
(937) 208-8155
(937) 208-8140
Mailing address
2180 GATEWAY DR, FAIRBORN, OH 45324-6356
(937) 208-8155
(937) 208-8140

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-089208
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2781673
OH
Enumeration date
05/14/2007
Last updated
12/06/2013
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