MEDICARE: RAMESH KODAVATIGANTI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	MD433055	PA
2	207LP3000X	Pediatric Anesthesiology Physician	MD433055	PA
3	207L00000X	Anesthesiology Physician	MD433055	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	119106	OTHER	PA	MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MD433055	OTHER	PA	MEDICAL LICENSE
3	G83996	OTHER	PA	UPIN

General Provider Information

NPI Number	:	1174529440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMESH KODAVATIGANTI M.D.

Provider Business Mailing Address
First Line	:	601 MEMORY LN
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-2231
Country	:	US
Telephone Number	:	717-812-7687
Fax Number	:	717-851-6969

Provider Business Practice Location Address
First Line	:	34TH STREET AND CIVIC CENTER BOULEVARD
Second Line	:	SUITE 9329
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4399
Country	:	US
Telephone Number	:	215-590-1867
Fax Number	:	215-590-5824

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	01/14/2026

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