Basic Information
Provider Information
NPI: 1295795714
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DASARI
FirstName: RAMA
MiddleName: SIRISHA
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 839 W CONGRESS ST
Address2:  
City: TUCSON
State: AZ
PostalCode: 857452819
CountryCode: US
TelephoneNumber: 5207929890
FaxNumber: 5208849287
Practice Location
Address1: 1500 W COMMERCE CT
Address2:  
City: TUCSON
State: AZ
PostalCode: 857466015
CountryCode: US
TelephoneNumber: 5206703909
FaxNumber: 5208062625
Other Information
ProviderEnumerationDate: 03/27/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0300X36219AZY Allopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine

No ID Information.


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