Provider Demographics
NPI:1013076314
Name:RAMAIAH, MANJUNATH (MD)
Entity Type:Individual
Prefix:
First Name:MANJUNATH
Middle Name:
Last Name:RAMAIAH
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 1:956 COURT AVE
Mailing Address - Street 2:SUITE # B226
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2814
Mailing Address - Country:US
Mailing Address - Phone:601-307-1156
Mailing Address - Fax:901-448-5764
Practice Address - Street 1:415 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7246
Practice Address - Country:US
Practice Address - Phone:601-288-4329
Practice Address - Fax:601-288-3191
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19552208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS7218869OtherAETNA
MSP00406872OtherRAILROAD MEDICARE
MS01602858Medicaid
LA1193526Medicaid
MS01602858Medicaid
MS110003004Medicare ID - Type Unspecified