1205009891 NPI number — DR. RADHAKRISHNAN RAMARAJ MD

Table of content: DR. RADHAKRISHNAN RAMARAJ MD (NPI 1205009891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205009891 NPI number — DR. RADHAKRISHNAN RAMARAJ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMARAJ
Provider First Name:
RADHAKRISHNAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205009891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
710 ERWIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28334-4522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-304-1212
Provider Business Mailing Address Fax Number:
910-292-2627

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 ERWIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28334-4522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-304-1212
Provider Business Practice Location Address Fax Number:
910-292-2627
Provider Enumeration Date:
04/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207UN0901X , with the licence number:  2014-01190 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 2014-01190 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 2014-01190 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 2014-01190 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1205009891 . This is a "HEALTHY BLUE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1205009891 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1205009891 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1205009891 . This is a "UNITED MEDICARE ADVANTAGE- AARP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1205009891 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1205009891 . This is a "CAROLINA COMPLETE HEALTH( CENTENE)" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1205009891 . This is a "BLUECROSS BLUESHIELD OF NORTH CAROLINA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1205009891 . This is a "WELLCARE( MEDICARE ADVANTAGE)" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1205009891 . This is a "UNITED HEALTH CARE MEDICARE ADVANTAGE- COMMUNITY" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1205009891 . This is a "HUMANA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1205009891 . This is a "AMBETTER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1205009891 . This is a "HUMANA MILITARY" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1205009891 . This is a "BLUE MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1205009891 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1205009891 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1205009891 . This is a "AMERIHEALTH CARITAS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1205009891 . This is a "VETERANS AFFAIRS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1205009891 . This is a "WELLCARE( MEDICAID)" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1205009891 . This is a "MULTIPLAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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