Healthcare Provider Details

I. General information

NPI: 1144068131
Provider Name (Legal Business Name): RAJATH RAMEGOWDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE FL 3
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1547
  • Fax:
Mailing address:
  • Phone: 617-355-6936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberSPI961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: