Provider Demographics
NPI:1457353252
Name:TATINENI, RAMAKRISHNA (MD)
Entity Type:Individual
Prefix:
First Name:RAMAKRISHNA
Middle Name:
Last Name:TATINENI
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 1:750 KINGS HWY
Mailing Address - Street 2:STE 103
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1772
Mailing Address - Country:US
Mailing Address - Phone:302-645-7050
Mailing Address - Fax:302-645-8473
Practice Address - Street 1:750 KINGS HWY
Practice Address - Street 2:STE 103
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1772
Practice Address - Country:US
Practice Address - Phone:302-645-7050
Practice Address - Fax:302-645-8473
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0006613208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000846001Medicaid
H69499Medicare UPIN
DE0000846001Medicaid