Provider Demographics
NPI:1366594848
Name:SUNRAYS CARDIOLOGY INC
Entity type:Organization
Organization Name:SUNRAYS CARDIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VENKATARAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GADDAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-252-7561
Mailing Address - Street 1:1492 E BROAD ST
Mailing Address - Street 2:SUITE 1401
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205
Mailing Address - Country:US
Mailing Address - Phone:614-252-7564
Mailing Address - Fax:614-252-7564
Practice Address - Street 1:71 SOUTH TERRACE AVENUE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055
Practice Address - Country:US
Practice Address - Phone:614-252-7561
Practice Address - Fax:614-252-7564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084203207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2486797Medicaid
OHGA4132851Medicare ID - Type Unspecified
9350791Medicare PIN
OH2486797Medicaid