Provider Demographics
NPI:1508881335
Name:PIDIKITI, RAMA D (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMA
Middle Name:D
Last Name:PIDIKITI
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 1:1321 MCFARLAND BLVD E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404
Mailing Address - Country:US
Mailing Address - Phone:205-758-1833
Mailing Address - Fax:205-758-8880
Practice Address - Street 1:1321 MCFARLAND BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404
Practice Address - Country:US
Practice Address - Phone:205-758-1833
Practice Address - Fax:205-758-8880
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13295225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051555395PIDMedicare ID - Type Unspecified
H62433Medicare UPIN