Healthcare Provider Details

I. General information

NPI: 1417224684
Provider Name (Legal Business Name): RAMMURTI ANTHONY MCKENZIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 PARK AVE STE 310
QUAKERTOWN PA
18951-1087
US

IV. Provider business mailing address

1534 PARK AVE STE 310
QUAKERTOWN PA
18951-1087
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-7246
  • Fax: 866-291-6192
Mailing address:
  • Phone: 484-526-7246
  • Fax: 866-291-6192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MA09886800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MA09886800
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD462865
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: