Healthcare Provider Details

I. General information

NPI: 1588947600
Provider Name (Legal Business Name): RAMNARINE BOODOO M.B.B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2011
Last Update Date: 03/08/2023
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 NORTHEAST DR
HERSHEY PA
17033-2732
US

IV. Provider business mailing address

500 UNIVERSITY DRIVE
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-1455
  • Fax: 717-531-6250
Mailing address:
  • Phone: 800-243-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36019
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD469622
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number36019
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD469622
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierNONE
Identifier TypeOTHER
Identifier State
Identifier IssuerNONE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: