Healthcare Provider Details

I. General information

NPI: 1710175278
Provider Name (Legal Business Name): RAGHAV RAMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 COYLE AVE STE 180
CARMICHAEL CA
95608-0303
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-536-3666
  • Fax: 916-536-3515
Mailing address:
  • Phone: 916-379-2871
  • Fax: 916-853-4730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA97250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: