Provider Demographics
NPI:1982659702
Name:EKAMBARAM, RAJAPPA (MD)
Entity Type:Individual
Prefix:
First Name:RAJAPPA
Middle Name:
Last Name:EKAMBARAM
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 1:4717 UNIVERSITY DR NW STE 109
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35816-3460
Mailing Address - Country:US
Mailing Address - Phone:256-890-8700
Mailing Address - Fax:256-890-8989
Practice Address - Street 1:4717 UNIVERSITY DR NW STE 109
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-3460
Practice Address - Country:US
Practice Address - Phone:256-890-8700
Practice Address - Fax:256-890-8989
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL10375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51009976OtherBLUE CROSS BLUE SHIELD
AL51510738OtherBC PROVIDER NUMBER
AL51009975OtherBLUE CROSS BLUE SHIELD
AL51510738OtherBC PROVIDER NUMBER
AL043690150OtherTAX ID NUMBER
AL51009976OtherBLUE CROSS BLUE SHIELD