Basic Information
| Provider Information | |||||||||
| NPI: | 1306024815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POLISETTY | ||||||||
| FirstName: | RAMA | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27212 CALAROGA AVE | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945454339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107855000 | ||||||||
| FaxNumber: | 5107842502 | ||||||||
| Practice Location | |||||||||
| Address1: | 27212 CALAROGA AVE | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945454339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107855000 | ||||||||
| FaxNumber: | 5107842502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2008 | ||||||||
| LastUpdateDate: | 02/06/2008 | ||||||||
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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 | 207V00000X | A93133 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | A93133 | 01 | CA | MEDICAL LICENSE NUMBER | OTHER |