Healthcare Provider Details

I. General information

NPI: 1679507651
Provider Name (Legal Business Name): RAMESH MUTYALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 TARBORO ST W STE 100
WILSON NC
27893-3481
US

IV. Provider business mailing address

1705 TARBORO ST SW
WILSON NC
27893-3437
US

V. Phone/Fax

Practice location:
  • Phone: 252-399-5314
  • Fax: 252-399-5315
Mailing address:
  • Phone: 252-399-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2006-01215
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: