Provider Demographics
NPI:1215926886
Name:SUDHEENDRA, RAMEGOWDA (MD)
Entity type:Individual
Prefix:MR
First Name:RAMEGOWDA
Middle Name:
Last Name:SUDHEENDRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 HWY 52 W BY PASS
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37186
Mailing Address - Country:US
Mailing Address - Phone:615-644-4203
Mailing Address - Fax:615-644-4228
Practice Address - Street 1:1124 HWY 52 W BY PASS
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:TN
Practice Address - Zip Code:37186
Practice Address - Country:US
Practice Address - Phone:615-644-4203
Practice Address - Fax:615-644-4228
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD36132207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3372335Medicare ID - Type UnspecifiedGROUP
TN3879285Medicare UPIN
TNH75725Medicare UPIN