Basic Information
| Provider Information | |||||||||
| NPI: | 1174518443 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMARAVADI | ||||||||
| FirstName: | RAMANA | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | AMAR | ||||||||
| OtherFirstName: | RAMANA | ||||||||
| OtherMiddleName: | V | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14020 N 46TH ST | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336134018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139722000 | ||||||||
| FaxNumber: | 8139727605 | ||||||||
| Practice Location | |||||||||
| Address1: | 14020 N 46TH ST | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336134018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139722000 | ||||||||
| FaxNumber: | 8139727605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 09/29/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | ME0038310 | FL | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 28001 | 01 | UMC | OTHER | 82134 | 01 | METRA HEALTH | OTHER | 0073614 | 01 | GHI | OTHER | 51145 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 053214200 | 05 | FL | MEDICAID | 082134 | 01 | AUMED | OTHER | 2289630 | 01 | AETNA/HUMANA | OTHER | 00220 | 01 | WELLCARE | OTHER | 290014402 | 01 | RR MEDICARE | OTHER |