Individual
RAMA K. KETHINENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS
Contact information
Practice address
557 SANDHURST DR, FAYETTEVILLE, NC 28304-4433
(910) 484-8114
(910) 223-0511
Mailing address
30 N 1900 E RM 4R312, SALT LAKE CITY, UT 84132-0002
(801) 581-6709
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01070789A
IN
207R00000X
Internal Medicine Physician
35.125862
OH
207RN0300X
Nephrology Physician
11729248-1205
UT
207RN0300X
Nephrology Physician
Primary
2023-02989
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000766020
ANTHEM
IN
05
—
201078420
—
IN
Enumeration date
12/16/2011
Last updated
11/09/2023
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