Provider Demographics
NPI:1750657516
Name:KOTTA M RAMAMURTHY MD PA
Entity Type:Organization
Organization Name:KOTTA M RAMAMURTHY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KOTTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAMAMURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-634-9494
Mailing Address - Street 1:898 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2121
Mailing Address - Country:US
Mailing Address - Phone:732-634-9494
Mailing Address - Fax:732-634-4560
Practice Address - Street 1:898 GREEN ST
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2121
Practice Address - Country:US
Practice Address - Phone:732-634-9494
Practice Address - Fax:732-634-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
147258Medicare PIN