Individual
SURIANARAYANAN AMBALAVANAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 PRO DR STE D4, VANAN ENT & SINUS CENTER, CELINA, OH 45822-3307
(419) 586-6480
(419) 586-8509
Mailing address
200 SAINT CLAIR AVE, JTDM FAMILY PRACTICE LLC, SAINT MARYS, OH 45885-2400
(419) 394-3387
(419) 586-8509
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
35-090880
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1184652539
GROUP NPI
OH
05
—
2820755
—
OH
01
—
9934723
MEDICARE GROUP PTAN
OH
Enumeration date
04/10/2006
Last updated
08/05/2020
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