Provider Demographics
NPI:1861677734
Name:RAMANUJAM, CRYSTAL L (DPM)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:L
Last Name:RAMANUJAM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28319 FRANK TER
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-4479
Mailing Address - Country:US
Mailing Address - Phone:281-685-4333
Mailing Address - Fax:
Practice Address - Street 1:1303 MCCULLOUGH AVE STE 333
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5605
Practice Address - Country:US
Practice Address - Phone:210-227-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1887213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203738401Medicaid
TX8L15485Medicare PIN