Provider Demographics
NPI:1265889448
Name:RAMAMOORTHY, ROHINI
Entity type:Individual
Prefix:
First Name:ROHINI
Middle Name:
Last Name:RAMAMOORTHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 19TH STREET SOUTH
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4245 BALMORAL DR SW STE 102
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6456
Practice Address - Country:US
Practice Address - Phone:256-203-6676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2021-01-29
Deactivation Date:2021-01-13
Deactivation Code:
Reactivation Date:2021-01-26
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALMD.38637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program