Provider Demographics
NPI:1407837073
Name:NALLAMALA, RAMANN (MD)
Entity Type:Individual
Prefix:
First Name:RAMANN
Middle Name:
Last Name:NALLAMALA
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 1:420 LOWELL DR SE STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3755
Mailing Address - Country:US
Mailing Address - Phone:256-535-5992
Mailing Address - Fax:844-213-5223
Practice Address - Street 1:420 LOWELL DR SE STE 100
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3755
Practice Address - Country:US
Practice Address - Phone:256-535-5992
Practice Address - Fax:844-213-5223
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21076207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009911324Medicaid
0007934344OtherAETNA
110237754OtherRAILROAD MEDICARE
631285668OtherTAX ID
AL051509140Medicaid
AL51541552OtherBLUE CROSS BLUE SHIELD
H58998Medicare UPIN
AL051509140Medicaid