Provider Demographics
NPI:1902802325
Name:CHANDRASEKHARA, RAMASWAMAIAH (MD)
Entity Type:Individual
Prefix:
First Name:RAMASWAMAIAH
Middle Name:
Last Name:CHANDRASEKHARA
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 1:37908 DAUGHTERY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-1316
Mailing Address - Country:US
Mailing Address - Phone:813-780-8620
Mailing Address - Fax:813-780-8619
Practice Address - Street 1:508 N ALEXANDER ST
Practice Address - Street 2:UNIT 1
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3036
Practice Address - Country:US
Practice Address - Phone:813-759-6607
Practice Address - Fax:813-759-8997
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME32636207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271794800Medicaid
FLME32636OtherLICENSE
FL'037215300Medicaid
FL'037215300Medicaid
FL53544UMedicare ID - Type Unspecified