Provider Demographics
NPI:1891880159
Name:GOLLAPUDI, RAMAKRISHNA P (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMAKRISHNA
Middle Name:P
Last Name:GOLLAPUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAM
Other - Middle Name:
Other - Last Name:GOLLAPUDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3687 MT DIABLO BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 JOHN MUIR PKWY STE 175
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5185
Practice Address - Country:US
Practice Address - Phone:925-756-3400
Practice Address - Fax:510-506-7727
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117810207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48964OtherSTATE MEDICAL LICENSE
CAE18837OtherMEDICARE UPIN