Healthcare Provider Details

I. General information

NPI: 1275187684
Provider Name (Legal Business Name): CHIDAMBARAM RAMASAMY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 ROGERS AVE STE 200
FORT SMITH AR
72903-4022
US

IV. Provider business mailing address

7001 ROGERS AVE STE 200
FORT SMITH AR
72903-4022
US

V. Phone/Fax

Practice location:
  • Phone: 479-314-7490
  • Fax: 479-314-7494
Mailing address:
  • Phone: 479-314-7490
  • Fax: 479-314-7494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number280025
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberE-19946
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: