Provider Demographics
NPI:1619015575
Name:RAMBALLY, CHERRIDAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHERRIDAN
Middle Name:
Last Name:RAMBALLY
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 1:944 OAK RIDGE TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830
Mailing Address - Country:US
Mailing Address - Phone:865-835-3810
Mailing Address - Fax:865-835-3811
Practice Address - Street 1:944 OAK RIDGE TPKE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6917
Practice Address - Country:US
Practice Address - Phone:865-835-3810
Practice Address - Fax:865-835-3811
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420011690207RS0012X
VT06000034262084N0400X
TN450912084N0400X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3734041Medicare PIN