Provider Demographics
NPI:1366413312
Name:MAKKENA, RAMACHANDRA RAO (MD)
Entity type:Individual
Prefix:DR
First Name:RAMACHANDRA
Middle Name:RAO
Last Name:MAKKENA
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:PO BOX 694
Mailing Address - Street 2:
Mailing Address - City:QUANAH
Mailing Address - State:TX
Mailing Address - Zip Code:79252-0694
Mailing Address - Country:US
Mailing Address - Phone:940-663-6151
Mailing Address - Fax:
Practice Address - Street 1:200 W 5TH ST
Practice Address - Street 2:
Practice Address - City:QUANAH
Practice Address - State:TX
Practice Address - Zip Code:79252-4704
Practice Address - Country:US
Practice Address - Phone:940-663-6151
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1140207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00QK81Medicare ID - Type Unspecified
TXC18697Medicare UPIN