Provider Demographics
NPI:1710069158
Name:GUMPENI, RAMMOHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMMOHAN
Middle Name:
Last Name:GUMPENI
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 1:7568 187TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1726
Mailing Address - Country:US
Mailing Address - Phone:718-670-1405
Mailing Address - Fax:718-819-5388
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:#WA 100
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-1405
Practice Address - Fax:718-461-2943
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111523207RP1001X
NY111523-1207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
061205476GU01OtherFAMILY HEALTH PLUS
124016OtherAETNA HMO
5C6148OtherHEALTHNET
11-3347168OtherMULTIPLAN
000000106306OtherGHI HMO
0C048POtherHIP
10209256OtherAMERIGROUP
4231839OtherAETNA PPO / POS
431637NOtherCIGNA
DS486OtherOXFORD
000084001OtherAMERICHOICE
000197150101OtherHEALTHPLUS
11P6421OtherNYPRESBYTERIAN CHP
160039OtherELDERPLAN
NY00200793Medicaid
0074822OtherGHI PPO
100027142401OtherUNITED HEALTHCARE
693961OtherEMPIRE BC/BS