Provider Demographics
NPI:1356382295
Name:PAMULA, RAMESH B (MD)
Entity type:Individual
Prefix:DR
First Name:RAMESH
Middle Name:B
Last Name:PAMULA
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 1:7085 N CHESTNUT AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0353
Mailing Address - Country:US
Mailing Address - Phone:559-935-5491
Mailing Address - Fax:559-935-5719
Practice Address - Street 1:7085 N CHESTNUT AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0353
Practice Address - Country:US
Practice Address - Phone:559-935-5491
Practice Address - Fax:559-935-5719
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55426208G00000X
LAMD203285174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSI04834Medicare UPIN
LA4M2596751Medicare UPIN
MS020000497Medicare ID - Type UnspecifiedMEDIARE
MS07632278Medicaid