Provider Demographics
NPI:1881867448
Name:KONGARA, RAMA K (MD)
Entity Type:Individual
Prefix:
First Name:RAMA
Middle Name:K
Last Name:KONGARA
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 1:5425 BRITTANY DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9144
Mailing Address - Country:US
Mailing Address - Phone:225-767-3372
Mailing Address - Fax:225-767-3262
Practice Address - Street 1:5425 BRITTANY DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9144
Practice Address - Country:US
Practice Address - Phone:225-767-3372
Practice Address - Fax:225-767-3262
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06039R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1353736Medicaid
LAB89258Medicare UPIN
LA1353736Medicaid