Active NPI
Mary Kuruvilla, MD
- Psychiatry Physician
- Dayton, OH
National Provider Identifier
1497973143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 35056398OHIO
- Practice address
- 1520 Germantown St
Dayton, OH 45408-1318 - Phone
- (937) 222-8111
- Fax
- (937) 496-2943
- NPI assigned
- Apr 20, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 35056398OHIO | OH | Primary |
Addresses
Primary practice location
1520 Germantown St
Dayton, OH 45408-1318
Mailing address
5070 Pebblebrook Dr
Englewood, OH 45322
Phone (937) 832-1320
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2961166 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35056398OHIO | OH | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429056000000",
"number": "1497973143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5070 PEBBLEBROOK DR",
"city": "ENGLEWOOD",
"state": "OH",
"postal_code": "45322",
"telephone_number": "937-832-1320",
"fax_number": "937-496-2943"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1520 GERMANTOWN ST",
"city": "DAYTON",
"state": "OH",
"postal_code": "454081318",
"telephone_number": "937-222-8111",
"fax_number": "937-496-2943"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KURUVILLA",
"first_name": "MARY",
"name_prefix": "Mrs.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-20",
"last_updated": "2015-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "OH",
"license": "35056398OHIO",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2961166",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.