Healthcare Provider Details

I. General information

NPI: 1295724938
Provider Name (Legal Business Name): RAM V.RAYASAM.M.D.P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S 2ND ST MORRISPARK
PHILLIPSBURG NJ
08865-1807
US

IV. Provider business mailing address

207 S 2ND ST MORRISPARK
PHILLIPSBURG NJ
08865-1807
US

V. Phone/Fax

Practice location:
  • Phone: 908-454-2279
  • Fax: 908-454-5404
Mailing address:
  • Phone: 908-454-2279
  • Fax: 908-454-5404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberMA38051
License Number StateNJ

VIII. Authorized Official

Name: DR. RAMAKUMAR VENKATA RAYASAM
Title or Position: PRESIDENT
Credential: M.D.,
Phone: 908-454-2279