Provider Demographics
NPI:1871592568
Name:DAVESSAR, NITIN (MD)
Entity type:Individual
Prefix:
First Name:NITIN
Middle Name:
Last Name:DAVESSAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 638269
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:440-816-4546
Mailing Address - Fax:
Practice Address - Street 1:18780 BAGLEY RD STE 200
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3304
Practice Address - Country:US
Practice Address - Phone:440-816-4546
Practice Address - Fax:440-816-4549
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH074366207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2072251Medicaid
OH2072251Medicaid
0857861Medicare ID - Type Unspecified