Provider Demographics
NPI:1447227509
Name:SWAMY, SAMALA RAMA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMALA
Middle Name:RAMA
Last Name:SWAMY
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 1:1366 VICTORY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3907
Mailing Address - Country:US
Mailing Address - Phone:718-442-8351
Mailing Address - Fax:718-442-4073
Practice Address - Street 1:1366 VICTORY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3907
Practice Address - Country:US
Practice Address - Phone:718-442-8351
Practice Address - Fax:718-442-4073
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129686174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C05170Medicare UPIN
NY07A501Medicare PIN