Basic Information
| Provider Information | |||||||||
| NPI: | 1255367694 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAKANI | ||||||||
| FirstName: | RAMANAIAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2075 GLENN MITCHELL DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234560179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572529365 | ||||||||
| FaxNumber: | 7579627217 | ||||||||
| Practice Location | |||||||||
| Address1: | 2075 GLENN MITCHELL DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234560179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572529365 | ||||||||
| FaxNumber: | 7579627217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 06/08/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 0101052433 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | PAR | 01 | VA | USA MANAGED CARE | OTHER | 638219 | 01 | VA | UHC/MAMSI | OTHER | 438219 | 01 | VA | MAMSI | OTHER | PAR | 01 | VA | CORVEL/CORCARE | OTHER | 790666P | 05 | NC | MEDICAID | PAR | 01 | VA | MULTIPLAN | OTHER | -001 | 01 | VA | TRICARE/CHAMPUS (EVMS HEALTH SERVICES) | OTHER | 010226554 | 05 | VA | MEDICAID | 187099 | 01 | VA | ANTHEM BC/BS | OTHER | 269848 | 01 | VA | ANTHEM | OTHER | 351666 | 01 | VA | OPTIMA HEALTH PLAN | OTHER | PAR | 01 | VA | CIGNA | OTHER | PAR | 01 | VA | VIRGINIA PREMIER HEALTH (EVMS HEALTH SERVICES) | OTHER | 10015736 | 01 | VA | SENTARA OPTIMA | OTHER | 1255367694 | 05 | VA | MEDICAID | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY | OTHER | 0666P | 01 | NC | NC BC/BS | OTHER | PAR | 01 | VA | AETNA | OTHER |