Provider Demographics
NPI:1417995820
Name:BRAHMAMDAM, RANGA S (MD)
Entity Type:Individual
Prefix:DR
First Name:RANGA
Middle Name:S
Last Name:BRAHMAMDAM
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 1:5520 CHEVIOT ROAD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7069
Mailing Address - Country:US
Mailing Address - Phone:513-451-4033
Mailing Address - Fax:513-451-4118
Practice Address - Street 1:5520 CHEVIOT ROAD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-7069
Practice Address - Country:US
Practice Address - Phone:513-451-4033
Practice Address - Fax:513-451-4118
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.073663207RH0003X
OH35-073663B207RX0202X
OH35-87785207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2102665Medicaid
G24371Medicare UPIN
OH2102665Medicaid
OH0842327Medicare PIN
0842324Medicare PIN