Provider Demographics
NPI:1568461176
Name:RAMAN, GAYATHRI V (MD)
Entity Type:Individual
Prefix:
First Name:GAYATHRI
Middle Name:V
Last Name:RAMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16216 BAXTER RD STE 325
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4771
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16216 BAXTER RD STE 325
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4771
Practice Address - Country:US
Practice Address - Phone:636-777-8058
Practice Address - Fax:636-777-8059
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001021531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7841537OtherAETNA
MO123858OtherGROUP HEALTH PLAN
MO160467OtherBLUE CROSS/BLUE SHIELD
MO487289OtherHEALTHLINK
MO123858OtherGROUP HEALTH PLAN
MO053010612Medicare ID - Type Unspecified
MO080185257OtherRR MEDICARE