Healthcare Provider Details

I. General information

NPI: 1184958035
Provider Name (Legal Business Name): DR. RAMANA REDDY GUDURU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DRIVE
MORGANTOWN WV
26507-7911
US

IV. Provider business mailing address

206 UPPER VIEW COURT
GREER SC
29651
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-1964
  • Fax:
Mailing address:
  • Phone: 864-419-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number24908
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number79580
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD36308
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: