Provider Demographics
NPI:1417054735
Name:MOGALLAPU, RATNASRI V (MD)
Entity Type:Individual
Prefix:
First Name:RATNASRI
Middle Name:V
Last Name:MOGALLAPU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 AVALON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2692
Mailing Address - Country:US
Mailing Address - Phone:314-479-4340
Mailing Address - Fax:
Practice Address - Street 1:VA MEDCIAL CENTER (116 A/JB)
Practice Address - Street 2:
Practice Address - City:ONE JEFFERSON BARRACKS DR
Practice Address - State:MO
Practice Address - Zip Code:63125
Practice Address - Country:US
Practice Address - Phone:314-487-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060069762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry