Provider Demographics
NPI:1528104015
Name:RAMAMURTHY, KOTTA M (MD)
Entity type:Individual
Prefix:
First Name:KOTTA
Middle Name:M
Last Name:RAMAMURTHY
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 1:898 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2121
Mailing Address - Country:US
Mailing Address - Phone:732-634-9494
Mailing Address - Fax:732-634-4560
Practice Address - Street 1:898 GREEN ST
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830
Practice Address - Country:US
Practice Address - Phone:732-634-9494
Practice Address - Fax:732-634-4560
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA025141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3012603Medicaid
NJC53558Medicare UPIN
NJ3012603Medicaid