MEDICARE: GAUTAM RAMAKRISHNA 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	207RC0000X	Cardiovascular Disease Physician	0101237937	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00230443	OTHER	DC	RAILROAD MEDICARE DC #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801896097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAUTAM RAMAKRISHNA M.D.

Provider Business Mailing Address
First Line	:	2901 TELESTAR CT.
Second Line	:	#300
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-1263
Country	:	US
Telephone Number	:	703-591-1688
Fax Number	:	703-591-1445

Provider Business Practice Location Address
First Line	:	3580 JOSEPH SIEWICK DR STE 305
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-1764
Country	:	US
Telephone Number	:	703-648-3266
Fax Number	:	703-648-3264

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	08/27/2021

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Directions to “ GAUTAM RAMAKRISHNA M.D.” Practice Location

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