Provider Demographics
NPI:1649381690
Name:SHATAGOPAM, RAMESH (MD)
Entity Type:Individual
Prefix:
First Name:RAMESH
Middle Name:
Last Name:SHATAGOPAM
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 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3175
Mailing Address - Fax:812-242-3543
Practice Address - Street 1:1429 N 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1037
Practice Address - Country:US
Practice Address - Phone:812-232-0564
Practice Address - Fax:812-242-3543
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048847A207RC0000X
IL36111955207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0182822OtherUS DEPT OF LABOR
471334OtherHEALTHLINK
INP00855812OtherRAILROAD MEDICARE
INP00828502OtherRAILROAD MEDICARE
IN200374390Medicaid
778240OtherAETNA
P00393763OtherRAILROAD MEDICARE
7690262001OtherCIGNA
IN200374390ZMedicaid
N289136OtherHARMONY HEALTH PLAN IND
IN200374390LMedicaid
351904269120OtherCARESOURCE MEDICAID
7789240OtherAETNA
000000224022OtherANTHEM
060068689OtherRAILROAD MCARE PALAMETTO
IN200374390AOtherMOLINA HEALTHCARE MCAID
IN859910SSSMedicare PIN
N289136OtherHARMONY HEALTH PLAN IND
351904269120OtherCARESOURCE MEDICAID
7789240OtherAETNA
IN265130DMedicare PIN
IN200374390ZMedicaid
ILIL3294001Medicare PIN