Provider Demographics
NPI:1386626968
Name:RAMAMURTHY, MANGALA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MANGALA
Middle Name:M
Last Name:RAMAMURTHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-0627
Mailing Address - Country:US
Mailing Address - Phone:956-631-3982
Mailing Address - Fax:956-631-0254
Practice Address - Street 1:1200 E RIDGE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1527
Practice Address - Country:US
Practice Address - Phone:956-631-3982
Practice Address - Fax:956-631-0254
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4977207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123546702Medicaid
TX123546702Medicaid
TX85911NMedicare PIN