Provider Demographics
NPI:1003850389
Name:RAMESHBABU, ALAGUSIVAKUMARI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAGUSIVAKUMARI
Middle Name:
Last Name:RAMESHBABU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALAGUSIVAKUMARI
Other - Middle Name:
Other - Last Name:RAMESHBABU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1928 SMARTY JONES DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10648 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8407
Practice Address - Country:US
Practice Address - Phone:704-667-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01304207RG0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT78804Medicaid
H76390Medicare UPIN
SCH76390Medicare ID - Type Unspecified