Basic Information
Provider Information | |||||||||
NPI: | 1508026881 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AYYALA | ||||||||
FirstName: | RAMA | ||||||||
MiddleName: | S. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3333 BURNET AVE | ||||||||
Address2: |   | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 452293026 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5136364251 | ||||||||
FaxNumber: | 5136368145 | ||||||||
Practice Location | |||||||||
Address1: | 3333 BURNET AVE | ||||||||
Address2: |   | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 452293026 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5136364251 | ||||||||
FaxNumber: | 5136368145 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/11/2008 | ||||||||
LastUpdateDate: | 08/28/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/28/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 254713 | NY | N |   | Other Service Providers | Specialist |   | 2085R0202X | MD16135 | RI | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 35.139974 | OH | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085P0229X | 35.139974 | OH | N |   | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology |
ID Information
ID | Type | State | Issuer | Description | 254713 | 01 | NY | NY LICENSE | OTHER |