Provider Demographics
NPI:1649210428
Name:PATNAIK, RAMPRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMPRASAD
Middle Name:
Last Name:PATNAIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAMPRASAD
Other - Middle Name:
Other - Last Name:PATNAIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7515 STENTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-3710
Mailing Address - Country:US
Mailing Address - Phone:267-335-5264
Mailing Address - Fax:267-335-5273
Practice Address - Street 1:5000 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3642
Practice Address - Country:US
Practice Address - Phone:215-848-9900
Practice Address - Fax:215-848-4694
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037052L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine