Provider Demographics
NPI:1700056280
Name:THAILA RAMANUJAM M D INC
Entity Type:Organization
Organization Name:THAILA RAMANUJAM M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:THAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMANUJAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-462-8960
Mailing Address - Street 1:1505 SOQUEL DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1716
Mailing Address - Country:US
Mailing Address - Phone:831-462-8960
Mailing Address - Fax:
Practice Address - Street 1:1505 SOQUEL DR
Practice Address - Street 2:SUITE 9
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1716
Practice Address - Country:US
Practice Address - Phone:831-462-8960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF33532Medicare UPIN