Provider Demographics
NPI:1083600522
Name:DAGGUBATI, RAMESH (MD)
Entity Type:Individual
Prefix:
First Name:RAMESH
Middle Name:
Last Name:DAGGUBATI
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 1:259 1ST ST
Mailing Address - Street 2:WINTHROP UNIVERSITY HOSPITAL, DEPARTMENT OF MEDICINE
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3957
Mailing Address - Country:US
Mailing Address - Phone:516-663-4480
Mailing Address - Fax:
Practice Address - Street 1:259 1ST ST
Practice Address - Street 2:WINTHROP UNIVERSITY HOSPITAL, DEPARTMENT OF MEDICINE
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:516-663-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00068207RI0011X
NY222210207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC151RTOtherBCBSNC
NCP00781447OtherMEDICARE RAILROAD
NC5911022Medicaid
NC2023398Medicare PIN