Provider Demographics
NPI:1023402864
Name:RAMMOHAN MARLA, P.C.
Entity type:Organization
Organization Name:RAMMOHAN MARLA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMMOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-613-4277
Mailing Address - Street 1:2570 24TH ST
Mailing Address - Street 2:STE 127
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5394
Mailing Address - Country:US
Mailing Address - Phone:309-779-4350
Mailing Address - Fax:309-779-4355
Practice Address - Street 1:2570 24TH ST
Practice Address - Street 2:STE 127
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5394
Practice Address - Country:US
Practice Address - Phone:309-779-4350
Practice Address - Fax:309-779-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036134953208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036134953OtherLICENSE