Provider Demographics
NPI:1659567055
Name:RAVULAPATI, AMITHA (MD)
Entity Type:Individual
Prefix:
First Name:AMITHA
Middle Name:
Last Name:RAVULAPATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMITHA
Other - Middle Name:REDDY
Other - Last Name:MORANGANTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4420 LAKE BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7505
Mailing Address - Country:US
Mailing Address - Phone:919-784-7093
Mailing Address - Fax:919-784-7395
Practice Address - Street 1:4420 LAKE BOONE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7505
Practice Address - Country:US
Practice Address - Phone:919-784-7093
Practice Address - Fax:919-784-7395
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT185944207R00000X
NC2012-01593208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC9681BMedicare PIN