Provider Demographics
NPI:1619924958
Name:MUNIYAPPA, RAMESH (MD)
Entity type:Individual
Prefix:DR
First Name:RAMESH
Middle Name:
Last Name:MUNIYAPPA
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 1:39 UPLANDS WAY
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3358
Mailing Address - Country:US
Mailing Address - Phone:718-874-2089
Mailing Address - Fax:
Practice Address - Street 1:41 BREWESTER ROAD
Practice Address - Street 2:BRISTOL HOSPITAL
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010
Practice Address - Country:US
Practice Address - Phone:718-874-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT054501207R00000X
PAMD429428207R00000X
TXM2414208M00000X
VA0101243449208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1619924958Medicaid
VAP00624002Medicare PIN
VA1619924958Medicaid
I48553Medicare UPIN
PAI48553Medicare UPIN
VAMC10037Medicare PIN