Provider Demographics
NPI:1023218484
Name:CHIDURALA, RAM MOHAN (MD)
Entity Type:Individual
Prefix:
First Name:RAM
Middle Name:MOHAN
Last Name:CHIDURALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5969 E BROAD ST STE 403
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1540
Mailing Address - Country:US
Mailing Address - Phone:142-347-5356
Mailing Address - Fax:614-234-6511
Practice Address - Street 1:5969 E BROAD ST STE 403
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1540
Practice Address - Country:US
Practice Address - Phone:142-347-5356
Practice Address - Fax:614-234-6511
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2023-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0086812207R00000X
OH35.094889207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine