Basic Information
Provider Information | |||||||||
NPI: | 1902802325 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHANDRASEKHARA | ||||||||
FirstName: | RAMASWAMAIAH | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 37908 DAUGHTERY RD | ||||||||
Address2: | SUITE A | ||||||||
City: | ZEPHYRHILLS | ||||||||
State: | FL | ||||||||
PostalCode: | 335411316 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8137808620 | ||||||||
FaxNumber: | 8137808619 | ||||||||
Practice Location | |||||||||
Address1: | 508 N ALEXANDER ST | ||||||||
Address2: | UNIT 1 | ||||||||
City: | PLANT CITY | ||||||||
State: | FL | ||||||||
PostalCode: | 335633036 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8137596607 | ||||||||
FaxNumber: | 8137598997 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/21/2005 | ||||||||
LastUpdateDate: | 01/19/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME32636 | FL | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
ID | Type | State | Issuer | Description | 271794800 | 05 | FL |   | MEDICAID | ME32636 | 01 | FL | LICENSE | OTHER | '037215300 | 05 | FL |   | MEDICAID |