Provider Demographics
NPI:1487621868
Name:AVUTU, RAMAGOPALA R (MD)
Entity type:Individual
Prefix:DR
First Name:RAMAGOPALA
Middle Name:R
Last Name:AVUTU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1530 NEEDMORE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-3969
Mailing Address - Country:US
Mailing Address - Phone:937-396-2602
Mailing Address - Fax:937-395-3682
Practice Address - Street 1:1530 NEEDMORE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3969
Practice Address - Country:US
Practice Address - Phone:937-396-2602
Practice Address - Fax:937-395-3682
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35035399207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0340705Medicaid
OH4250653Medicare PIN
OHAV0443962Medicare ID - Type Unspecified
E60818Medicare UPIN