Provider Demographics
NPI:1174521587
Name:AVVA, RAMESH (MD)
Entity type:Individual
Prefix:
First Name:RAMESH
Middle Name:
Last Name:AVVA
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 1:700 E MOREHEAD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2742
Mailing Address - Country:US
Mailing Address - Phone:704-334-7800
Mailing Address - Fax:704-414-7512
Practice Address - Street 1:700 E MOREHEAD ST STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2742
Practice Address - Country:US
Practice Address - Phone:704-334-7800
Practice Address - Fax:704-414-7512
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1090482085R0202X
SC340672085R0202X
KS04310082085R0202X
GA0485932085R0202X
MO20030189012085R0202X
NC2010-018802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00372766OtherMEDICARE RAILROAD
MOP00731414OtherRR MEDICARE
OKP00290368OtherMEDICARE RAILROAD
MO204886014Medicaid
MOP00377090OtherMEDICARE RAILROAD
KSP00908851OtherRR MEDICARE
MO1174521587Medicaid
OK100045270AMedicaid
KS100361770HMedicaid
AR134963001Medicaid
KS100361770DMedicaid
KS100361770HMedicaid
KSKA1172001Medicare PIN
MO906764868Medicare PIN
KS851174Medicare PIN
MOP00377090OtherMEDICARE RAILROAD
KSR82C843AMedicare PIN
OKOK700298Medicare PIN
KSK67A00007Medicare PIN
OK243536107Medicare PIN
NC2077464Medicare PIN
ILP00372766OtherMEDICARE RAILROAD
OK100045270AMedicaid
KS100361770DMedicaid
AR134963001Medicaid
MO056A00001Medicare PIN