Provider Demographics
NPI:1447368006
Name:TRIPURANENI, RAJAGOPALA RAO (MD)
Entity type:Individual
Prefix:
First Name:RAJAGOPALA
Middle Name:RAO
Last Name:TRIPURANENI
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 1:1328 SPRINGVALE DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-5848
Mailing Address - Country:US
Mailing Address - Phone:410-879-1907
Mailing Address - Fax:
Practice Address - Street 1:501 S UNION AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3409
Practice Address - Country:US
Practice Address - Phone:443-843-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD19031207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD489P946GMedicare PIN