Provider Demographics
NPI:1841252822
Name:RAMACHANDRA, NEERAJA (MD)
Entity type:Individual
Prefix:DR
First Name:NEERAJA
Middle Name:
Last Name:RAMACHANDRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4378
Mailing Address - Country:US
Mailing Address - Phone:248-312-8779
Mailing Address - Fax:248-267-8471
Practice Address - Street 1:4646 JOHN R ST
Practice Address - Street 2:VAMC
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1916
Practice Address - Country:US
Practice Address - Phone:313-576-4693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2009-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35. 080769207R00000X
MI4301089156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H58041Medicare UPIN
4073011Medicare PIN