Healthcare Provider Details

I. General information

NPI: 1457977993
Provider Name (Legal Business Name): RAMESH BETTAGERE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 WOODLONG DR
BATON ROUGE LA
70816-5511
US

IV. Provider business mailing address

1336 WOODLONG DR
BATON ROUGE LA
70816-5511
US

V. Phone/Fax

Practice location:
  • Phone: 225-324-6156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4050
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4050
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: