=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679568281
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMANARAO V METTU MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2005
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 911 BYPASS RD BLDG A
-----------------------------------------------------
City | PIKEVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41501-1689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-430-6409
-----------------------------------------------------
Fax | 606-218-7509
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 432
-----------------------------------------------------
City | PIKEVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41502-0432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-430-6409
-----------------------------------------------------
Fax | 606-218-7509
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RS0012X
-----------------------------------------------------
Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 21956
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------