Provider Demographics
NPI:1407900616
Name:RAMASASTRY, HARITHA (MD)
Entity Type:Individual
Prefix:
First Name:HARITHA
Middle Name:
Last Name:RAMASASTRY
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 540
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-0540
Mailing Address - Country:US
Mailing Address - Phone:205-280-3360
Mailing Address - Fax:205-280-3369
Practice Address - Street 1:1006 LAY DAM RD
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2306
Practice Address - Country:US
Practice Address - Phone:205-280-3360
Practice Address - Fax:205-280-3369
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17645207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000037045Medicaid
AL51037045OtherBCBS OF ALABAMA
AL000037045Medicaid
ALF73909Medicare UPIN