Provider Demographics
NPI:1922286699
Name:RAMARAO S GAJULA, MD, PA
Entity Type:Organization
Organization Name:RAMARAO S GAJULA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMARAO
Authorized Official - Middle Name:S
Authorized Official - Last Name:GAJULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-679-6558
Mailing Address - Street 1:28 THROCKMORTON LN
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2558
Mailing Address - Country:US
Mailing Address - Phone:732-679-2555
Mailing Address - Fax:732-679-3060
Practice Address - Street 1:28 THROCKMORTON LN
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2558
Practice Address - Country:US
Practice Address - Phone:732-679-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA00668592080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7610904Medicaid