Healthcare Provider Details

I. General information

NPI: 1356382295
Provider Name (Legal Business Name): RAMESH B PAMULA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7085 N CHESTNUT AVE STE 103
FRESNO CA
93720-0353
US

IV. Provider business mailing address

7085 N CHESTNUT AVE STE 103
FRESNO CA
93720-0353
US

V. Phone/Fax

Practice location:
  • Phone: 559-935-5491
  • Fax: 559-935-5719
Mailing address:
  • Phone: 559-935-5491
  • Fax: 559-935-5719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberC55426
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD203285
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: