Provider Demographics
NPI:1962485482
Name:TATA, RAMACHANDRA R (MD)
Entity Type:Individual
Prefix:
First Name:RAMACHANDRA
Middle Name:R
Last Name:TATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:255 HOSPITAL DR STE 208
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5801
Mailing Address - Country:US
Mailing Address - Phone:410-553-8160
Mailing Address - Fax:410-553-8159
Practice Address - Street 1:255 HOSPITAL DR STE 208
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5801
Practice Address - Country:US
Practice Address - Phone:410-553-8160
Practice Address - Fax:410-553-8159
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00928972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA551704OtherBCBS PA
PA0016988180003Medicaid
PA0016988180007Medicaid
PA130023680Medicare PIN
PA0016988180003Medicaid
PA551704Medicare PIN