Provider Demographics
NPI:1124078027
Name:TUMMALA, RAMACHANDRA PRASAD (MD)
Entity type:Individual
Prefix:MR
First Name:RAMACHANDRA
Middle Name:PRASAD
Last Name:TUMMALA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-9000
Mailing Address - Fax:
Practice Address - Street 1:310 SMITH AVE N STE 440
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2316
Practice Address - Country:US
Practice Address - Phone:651-241-6550
Practice Address - Fax:651-241-6586
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237509207T00000X
MN42776207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare ID - Type Unspecified