Provider Demographics
NPI:1801843297
Name:GAJULA, RAMARAO (MD)
Entity type:Individual
Prefix:DR
First Name:RAMARAO
Middle Name:
Last Name:GAJULA
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 1:1500 SAINT GEORGES AVE STE G
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1000
Mailing Address - Country:US
Mailing Address - Phone:732-382-8111
Mailing Address - Fax:732-381-0292
Practice Address - Street 1:1500 SAINT GEORGES AVE STE G
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1000
Practice Address - Country:US
Practice Address - Phone:732-382-8111
Practice Address - Fax:732-381-0292
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0066859208000000X
TX2663208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7610904Medicaid
NJ201782313OtherTAX IDENTIFICATION NUMBER