Provider Demographics
NPI:1225007917
Name:MADHAVARAPU, RAMCHANDER RAO (MD)
Entity Type:Individual
Prefix:
First Name:RAMCHANDER
Middle Name:RAO
Last Name:MADHAVARAPU
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 1:2120 EXCHANGE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3365
Mailing Address - Country:US
Mailing Address - Phone:503-325-7337
Mailing Address - Fax:503-325-3706
Practice Address - Street 1:2120 EXCHANGE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3365
Practice Address - Country:US
Practice Address - Phone:503-325-7337
Practice Address - Fax:503-325-3706
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25214208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR276048Medicaid
WA1119858Medicaid