Healthcare Provider Details

I. General information

NPI: 1316133580
Provider Name (Legal Business Name): S. RAMASAMY, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 GOLF COURSE RD SE SUITE 203
RIO RANCHO NM
87124-4728
US

IV. Provider business mailing address

1101 GOLF COURSE RD SE SUITE 203
RIO RANCHO NM
87124-4728
US

V. Phone/Fax

Practice location:
  • Phone: 505-234-1616
  • Fax: 505-234-1617
Mailing address:
  • Phone: 505-234-1616
  • Fax: 505-234-1617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number2003-0552
License Number StateNM

VIII. Authorized Official

Name: SENTHILKUMAR RAMASAMY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-234-1616