Provider Demographics
NPI:1396785606
Name:MEDARAMETLA, HANUMANTHARAO (MD)
Entity type:Individual
Prefix:
First Name:HANUMANTHARAO
Middle Name:
Last Name:MEDARAMETLA
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:401 MATTHEW ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1635
Practice Address - Country:US
Practice Address - Phone:740-376-1994
Practice Address - Fax:740-376-1940
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054969207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000505200OtherANTHEM
P00130258OtherMEDICARE RAILROAD
OHP00385096OtherRRMCR
WV1803285000Medicaid
OH000000643495OtherANTHEM
OH2188823Medicaid
OH000000643495OtherANTHEM
0870734Medicare PIN
OH7410261Medicare PIN