Provider Demographics
NPI:1700270469
Name:RAMESH B PAMULA MD INC
Entity Type:Organization
Organization Name:RAMESH B PAMULA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUPERNAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-935-5491
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55426174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty