Provider Demographics
NPI:1417152687
Name:DEGALA, RAMAMOHANA PRASAD (MD)
Entity type:Individual
Prefix:DR
First Name:RAMAMOHANA
Middle Name:PRASAD
Last Name:DEGALA
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 1:105 W BECKER DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4800
Mailing Address - Country:US
Mailing Address - Phone:252-535-2422
Mailing Address - Fax:252-535-1523
Practice Address - Street 1:105 W BECKER DR
Practice Address - Street 2:P.O DRAWER 1520
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4800
Practice Address - Country:US
Practice Address - Phone:252-535-2422
Practice Address - Fax:252-535-1523
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC307992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8928184Medicaid
1649262445OtherGROUP NPI#
1649262445OtherGROUP NPI#
E-10260Medicare UPIN
NC230791Medicare ID - Type UnspecifiedMECARE GROUP#