1396738282 NPI number — RAMA K GONDI MD

Table of content: RAMA K GONDI MD (NPI 1396738282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396738282 NPI number — RAMA K GONDI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONDI
Provider First Name:
RAMA
Provider Middle Name:
K
Provider Name Prefix Text:
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:
1396738282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11125 DUNN RD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63136-6132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-839-5522
Provider Business Mailing Address Fax Number:
314-839-5351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11125 DUNN RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63136-6132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-839-5522
Provider Business Practice Location Address Fax Number:
314-839-5351
Provider Enumeration Date:
08/25/2005

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: 207RC0000X , with the licence number:  036109540 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 2003012641 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 021291 . This is a "FMH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 566489 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00341379 . This is a "ILRRMCR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 8029043 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7471506 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000012077 . This is a "ESSENCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 195651 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 021291 . This is a "JFMOLLOY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 195651 . This is a "MO BC/BS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2299725 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: H86336 . This is a "MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 208998823 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231679 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: C50434 . This is a "MORRMCR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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