1124072145 NPI number — RAMA M NADELLA M.D.

Table of content: RAMA M NADELLA M.D. (NPI 1124072145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124072145 NPI number — RAMA M NADELLA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NADELLA
Provider First Name:
RAMA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1124072145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 WHITESPORT DR SW
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801-6454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-519-9181
Provider Business Mailing Address Fax Number:
256-519-9141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 WHITESPORT DR SW
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-6454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-519-9181
Provider Business Practice Location Address Fax Number:
256-519-9141
Provider Enumeration Date:
05/22/2006

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: 174400000X , with the licence number:  21198 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: MD.21198 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000077053 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000119315 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510-44759 . This is a "BLUE CROSS PROVIDER #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 721397168 . This is a "TAX I D" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 155455 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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