Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0011X | Interventional Cardiology | 2009-00068 | NC |
Y | 207RI0011X | Interventional Cardiology | 222210 | NY |
NPI | 1083600522 |
---|---|
Provider Name | Ramesh Daggubati |
First Address | Mineola, NY 11501-3957 |
Second Address | Mineola, NY 11501-3957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 10/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
151RT | BCBSNC (01) | NC |
5911022 | (05) | NC |
P00781447 | MEDICARE RAILROAD (01) | NC |