Provider Demographics
NPI:1063615391
Name:RAMANN NALLAMALA MD PC
Entity type:Organization
Organization Name:RAMANN NALLAMALA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMANN
Authorized Official - Middle Name:
Authorized Official - Last Name:NALLAMALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-535-5992
Mailing Address - Street 1:420 LOWELL DR SE STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3755
Mailing Address - Country:US
Mailing Address - Phone:256-535-5992
Mailing Address - Fax:844-213-5223
Practice Address - Street 1:420 LOWELL DR SE
Practice Address - Street 2:SUITE 103
Practice Address - City:HUNTSVILLLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-535-5940
Practice Address - Fax:256-535-5995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051509140Medicaid
AL51541552OtherBLUE CROSS & BLUE SHIELD
AL510G700061Medicare PIN
ALC73317Medicare UPIN