Provider Demographics
NPI:1215907209
Name:GAMMAGE, PUNYA RAMAN (MD)
Entity type:Individual
Prefix:
First Name:PUNYA
Middle Name:RAMAN
Last Name:GAMMAGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PUNYA
Other - Middle Name:K
Other - Last Name:RAMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:690 E WARNER RD
Mailing Address - Street 2:STE 133
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3057
Mailing Address - Country:US
Mailing Address - Phone:480-892-1212
Mailing Address - Fax:480-892-4941
Practice Address - Street 1:690 E WARNER RD STE 133
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3057
Practice Address - Country:US
Practice Address - Phone:480-892-1212
Practice Address - Fax:480-892-4941
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ533100Medicaid
AZ1215907209OtherBCBS
P01009157OtherRAILROAD MEDICARE PTAN
Z116647OtherMEDICARE PTAN
Z116647OtherMEDICARE PTAN
AZ62847Medicare ID - Type Unspecified