Provider Demographics
NPI:1093721896
Name:NANDURI, RAMACHANDER (MD,)
Entity Type:Individual
Prefix:
First Name:RAMACHANDER
Middle Name:
Last Name:NANDURI
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:RAMACHANDER
Other - Middle Name:
Other - Last Name:NANDURI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9253 REGENTS ROAD
Mailing Address - Street 2:BLD A-402
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9164
Mailing Address - Country:US
Mailing Address - Phone:559-246-3658
Mailing Address - Fax:858-535-1484
Practice Address - Street 1:995 GATEWAY MEDICAL CENTER
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102
Practice Address - Country:US
Practice Address - Phone:619-264-3107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC 50916207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C509160Medicaid
CAC 50916OtherMEDICAL LICENSE