Provider Demographics
NPI:1861475568
Name:RAMANA, CHIGURUPATI V (MD)
Entity Type:Individual
Prefix:DR
First Name:CHIGURUPATI
Middle Name:V
Last Name:RAMANA
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 1:145 TREVINO AVE
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-4200
Mailing Address - Country:US
Mailing Address - Phone:209-788-8180
Mailing Address - Fax:209-783-0036
Practice Address - Street 1:145 TREVINO AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-4200
Practice Address - Country:US
Practice Address - Phone:209-788-8180
Practice Address - Fax:209-783-0036
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1704712085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0141902Medicaid
300118852OtherRAILROAD
RA0703586Medicare PIN
F02979Medicare UPIN