Provider Demographics
NPI:1861401804
Name:RAMAKRISHNA, NAGAMALLI (MD)
Entity type:Individual
Prefix:MR
First Name:NAGAMALLI
Middle Name:
Last Name:RAMAKRISHNA
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 1:100 DELAFIELD ROAD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215
Mailing Address - Country:US
Mailing Address - Phone:412-784-1900
Mailing Address - Fax:412-784-5569
Practice Address - Street 1:100 DELAFIELD ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215
Practice Address - Country:US
Practice Address - Phone:412-784-1900
Practice Address - Fax:412-784-5569
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036832L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008048090003Medicaid
PA0008048090003Medicaid
93050Medicare ID - Type Unspecified