Provider Demographics
NPI:1174518443
Name:AMARAVADI, RAMANA V (MD)
Entity type:Individual
Prefix:
First Name:RAMANA
Middle Name:V
Last Name:AMARAVADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAMANA
Other - Middle Name:V
Other - Last Name:AMAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:14020 N 46TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4018
Mailing Address - Country:US
Mailing Address - Phone:813-972-2000
Mailing Address - Fax:813-972-7605
Practice Address - Street 1:14020 N 46TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4018
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:813-972-7605
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038310208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
28001OtherUMC
82134OtherMETRA HEALTH
0073614OtherGHI
51145OtherBLUE CROSS BLUE SHIELD
FL053214200Medicaid
082134OtherAUMED
2289630OtherAETNA/HUMANA
00220OtherWELLCARE
290014402OtherRR MEDICARE
2289630OtherAETNA/HUMANA
FL053214200Medicaid