Provider Demographics
NPI:1275589202
Name:GUDAPATI, RAMAKRISHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMAKRISHNA
Middle Name:
Last Name:GUDAPATI
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 1:310 PROSPECT AVE APT 223
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-7763
Mailing Address - Country:US
Mailing Address - Phone:201-880-7484
Mailing Address - Fax:
Practice Address - Street 1:310 PROSPECT AVE APT 223
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-7763
Practice Address - Country:US
Practice Address - Phone:201-880-7484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA076911002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI16615Medicare UPIN
NJ083422Medicare ID - Type Unspecified