Provider Demographics
NPI:1679730162
Name:CHIMAKURTHI, ROJA (MD)
Entity type:Individual
Prefix:
First Name:ROJA
Middle Name:
Last Name:CHIMAKURTHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MONTGOMERY RD
Mailing Address - Street 2:STE 105
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2697
Mailing Address - Country:US
Mailing Address - Phone:513-487-5305
Mailing Address - Fax:513-487-5317
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:STE 360
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5200
Practice Address - Country:US
Practice Address - Phone:513-217-5720
Practice Address - Fax:513-217-5729
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.129555207RN0300X
KY49460207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD037560800Medicaid
MD974970-01OtherCAREFIRST BC/BS
MDS062-0440OtherCAREFIRST BC/BS - REGIONAL
OHPENDINGMedicaid
MD037560800Medicaid
OHPENDINGMedicaid
OHPENDINGMedicare PIN