DR. RAM MOHAN BONGU (NPI# 1760485080) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760485080 |
| Entity Type | Individual |
| Full Name | DR. RAM MOHAN BONGU |
| Credential | MD |
| Practice Address |
101 Robeson St Ste 202 Fayetteville NC 28301-5520 |
| Mailing Address |
Po Box 40908 Fayetteville NC 28309-0908 |
| Practice Telephone | 9106091630 |
| Practice Fax Number | 9106091636 |
| Mailing Telephone | 9106096448 |
| Mailing Fax Number | 9106097040 |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2009-11-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
200300007 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 8913352 | 05 |
| Street Address |
101 ROBESON ST STE 202 |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28301-5520 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285637397 | Leon E Dantzler | Internal Medicine | 101 Robeson St, Suite 300, Fayetteville, NC 28301-5552 | 2005-05-23 |
| 1962014803 | Paige Greene | Pharmacist | 101 Robeson St, Fayetteville, NC 28301-5552 | 2020-08-21 |
| 1013536234 | Ashley Stone | Health Educator | 101 Robeson St, Fayetteville, NC 28301-5552 | 2020-04-09 |
| 1508242280 | Kelly Fynboe | Pharmacist | 101 Robeson St, Suite 107, Fayetteville, NC 28301-5552 | 2015-08-05 |
| 1720412968 | Autumn Lee Mittleider | Pharmacist | 101 Robeson St, Ste 202, Fayetteville, NC 28301-5552 | 2013-08-23 |
| 1447695994 | Erik Wiglama | Internal Medicine | 101 Robeson St, Suite 300, Fayetteville, NC 28301-5552 | 2013-05-09 |
| 1588952329 | John Pasztor | Dietitian, Registered | 101 Robeson St, Suite 410, Fayetteville, NC 28301-5552 | 2011-07-14 |
| 1497045496 | Nduche Chika Onyeaso | Internal Medicine | 101 Robeson St, Suite 405, Fayetteville, NC 28301-5552 | 2011-04-11 |
| 1982900247 | Samantha Moore Paquette | Pharmacist | 101 Robeson St, Suite 107, Fayetteville, NC 28301-5552 | 2011-02-03 |
| 1386970572 | Jamie Dickerhoff | Nurse Practitioner | 101 Robeson St, Suite 410, Fayetteville, NC 28301-5552 | 2009-10-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134726219 | Jenna Michelle Odneal | Behavior Technician | 16915 Liverpool Pkwy. Suite B., Cornelius, NC 28301 | 2020-10-02 |
| 1790390094 | Jessica Shellman | Counselor | 408 Person St. Ste 103, Fayetteville, NC 28301 | 2020-09-14 |
| 1487205951 | Martha K Richardson | Technician | 720 Teachers Dr, Fayetteville, NC 28301 | 2019-09-25 |
| 1013568161 | Angela Rena Locklear | Counselor | 211 Lamon St, Fayeteville, NC 28301 | 2019-09-20 |
| 1619535747 | Teresa Wilson | Contractor | 1417 Canyionland Ct, Apt 209, Fayetteville, NC 28301 | 2019-06-04 |
| 1912461815 | Catherine Stevenson Nwogalanya | Community Health Worker | 1103 Hillsboro St., Fayetteville, NC 28301 | 2019-01-24 |
| 1811443187 | Michael Carroll | Counselor | 308 Peterson Place, Fayetteville, NC 28301 | 2016-08-28 |
| 1023499886 | Latifa Fedai | Nurse Practitioner | 380 Person Street, Fayettevill, NC 28301 | 2015-06-17 |
| 1265868939 | Aci Support Specialists | Community/Behavioral Health | 1725 Venna Drive, Fayetteville, NC 28301 | 2013-09-25 |
| 1871929547 | Aci Support Specialists | Day Training, Developmentally Disabled Services | 2820 Copenhagen Drive, Fayetteville, NC 28301 | 2013-09-25 |
| Find all providers in zip 28301 | ||||
| Taxonomy Code | 207QG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Geriatric Medicine |
| A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://wwwtheabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316259013 | Graceful Aging,pc | Family Medicine | 2732 Bardolino Dr, Fayetteville, NC 28306-4636 | 2010-07-09 |
| 1932295342 | Larry Wayne Barnes | Family Medicine | 2330 Thornton Taylor Pkwy, Suite A, Fayetteville, TN 37334-3672 | 2006-10-04 |
| 1669436150 | Margaret H Taylor | Family Medicine | 1794 E. Joyce Blvd #2, Fayetteville, AR 72703 | 2006-04-13 |
| 1427253533 | Highland Rim Medical Center | Family Medicine | 2330 Thornton Taylor Pkwy, Suite A, Fayetteville, TN 37334-3630 | 2007-06-19 |
| 1639130008 | Subbarao Venkata Pemmaraju | Family Medicine | 2300 Ramsey St, Vamc, Division of Ltc/geriatrics, 11g, Fayetteville, NC 28301-3856 | 2006-03-28 |
| 1841293149 | Cumberland County Hospital Systems, Inc | Family Medicine | 101 Robeson St, Ste 202, Fayetteville, NC 28301-5520 | 2005-05-31 |
| 1346243664 | Joyce E Batson | Family Medicine | 101 Robeson St, Suite 202, Fayetteville, NC 28301-5552 | 2005-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649765058 | Frances Elizabeth Sutton | Family Medicine | 180 Southwood Dr, Clinton, NC 28328-5002 | 2018-06-27 |
| 1023313855 | Triangle Geriatrics & Palliative Medicine, Pllc | Family Medicine | 1010 Rosehill Ave, Durham, NC 27705-4019 | 2011-01-26 |
| 1306092549 | Coastal Mobile Medical Doctor, Pa | Family Medicine | 203 Stagecoach Dr, Jacksonville, NC 28546-9617 | 2008-08-07 |
| 1457541484 | North River Primecare PC | Family Medicine | 301 Jones Ave, Beaufort, NC 28516-1514 | 2007-07-26 |
| 1790812840 | Geridoc LLC | Family Medicine | 4431 Montibello Dr, Charlotte, NC 28226-7420 | 2007-02-27 |
| 1174658371 | Brunswick Gericare PC | Family Medicine | 602 Thomasboro Road, Calabash, NC 28467-9820 | 2007-02-21 |
| 1952446080 | Jeffrey Dean Martin | Family Medicine | North Carolina Disability Determination Services, 3301 Terminal Dr, Raleigh, NC 27602-0243 | 2007-02-20 |
| 1912048273 | Shine Thomas | Family Medicine | 1601 Brennar Ave, Salisbury, NC 28144-2515 | 2007-02-09 |
| 1982766283 | Balaji Pabbu | Family Medicine | 101 Heart Drive, Mail Stop 654, Greenville, NC 27834 | 2006-12-14 |
| 1417065236 | Narender D Arcot | Family Medicine | 31 Office Park Dr, Jacksonville, NC 28546-3219 | 2006-08-29 |
| Find all providers with the same taxonomy | ||||
| City | FAYETTEVILLE |
| Zip Code | 28301 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.