Healthcare Provider Details

I. General information

NPI: 1184650475
Provider Name (Legal Business Name): RAMESH KONERU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N DELAWARE AVE SUITE # 4D
PHILADELPHIA PA
19123-4226
US

IV. Provider business mailing address

14 FOX HUNT CIR
PLYMOUTH MEETING PA
19462-1428
US

V. Phone/Fax

Practice location:
  • Phone: 215-923-8042
  • Fax: 215-923-8064
Mailing address:
  • Phone: 610-567-0937
  • Fax: 215-923-8064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD063700L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD063700L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: