Healthcare Provider Details

I. General information

NPI: 1922097666
Provider Name (Legal Business Name): RAMAKUMAR VENKATA RAYASAM M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RAMAKUMAR V RAYASAM M.D.,

II. Dates (important events)

Enumeration Date: 10/16/2005
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S 2ND ST MORRIS PARK
PHILLIPSBURG NJ
08865-1807
US

IV. Provider business mailing address

207 S 2ND ST MORRIS PARK
PHILLIPSBURG NJ
08865-1807
US

V. Phone/Fax

Practice location:
  • Phone: 908-454-2279
  • Fax:
Mailing address:
  • Phone: 908-454-2279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberMA03805100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberMA03805100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: