Provider Demographics
NPI:1982671848
Name:KONAKANCHI, RAMESH (DO)
Entity Type:Individual
Prefix:
First Name:RAMESH
Middle Name:
Last Name:KONAKANCHI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5687 MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5517
Mailing Address - Country:US
Mailing Address - Phone:716-204-3541
Mailing Address - Fax:716-204-3542
Practice Address - Street 1:4184 SENECA ST
Practice Address - Street 2:SUITE 208
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3051
Practice Address - Country:US
Practice Address - Phone:716-559-3021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2100302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00025357701OtherUNIVERA
NY01988852Medicaid
NY00525514003OtherBLUE CROSS BLUE SHIELD
NY1511004OtherINDEPENDENT HEALTH
NY00025357701OtherUNIVERA
NY00525514003OtherBLUE CROSS BLUE SHIELD