Provider Demographics
NPI:1710007356
Name:PRATHIVADI, RAMAMANI B (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMAMANI
Middle Name:B
Last Name:PRATHIVADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RAMAMANI
Other - Middle Name:B
Other - Last Name:PRATHIVADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2501 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-5058
Mailing Address - Country:US
Mailing Address - Phone:325-795-3412
Mailing Address - Fax:325-795-3374
Practice Address - Street 1:2501 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-5058
Practice Address - Country:US
Practice Address - Phone:325-795-3412
Practice Address - Fax:325-795-3374
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE44196Medicare UPIN