Healthcare Provider Details

I. General information

NPI: 1154536100
Provider Name (Legal Business Name): REKHA RAMANUJA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 N LINDBERGH BLVD
SAINT LOUIS MO
63132-1704
US

IV. Provider business mailing address

1220 N LINDBERGH BLVD
SAINT LOUIS MO
63132-1704
US

V. Phone/Fax

Practice location:
  • Phone: 314-473-1394
  • Fax: 314-427-2682
Mailing address:
  • Phone: 314-473-1394
  • Fax: 314-427-2682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2010007405
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: