Provider Demographics
NPI:1174507461
Name:RAMAMURTHY, KANNAN (MD)
Entity Type:Individual
Prefix:
First Name:KANNAN
Middle Name:
Last Name:RAMAMURTHY
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:PO BOX 1689
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1630
Mailing Address - Country:US
Mailing Address - Phone:956-787-8915
Mailing Address - Fax:956-787-2021
Practice Address - Street 1:1200 E. SANTA ROSA
Practice Address - Street 2:
Practice Address - City:EDCOUCH
Practice Address - State:TX
Practice Address - Zip Code:78538
Practice Address - Country:US
Practice Address - Phone:956-262-1363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115385004Medicaid
TX115385004Medicaid
TXD18854Medicare UPIN