Healthcare Provider Details

I. General information

NPI: 1245790690
Provider Name (Legal Business Name): NIKHIL YEGYA-RAMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE STREET
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

800 SPRUCE STREET
PHILADELPHIA PA
19107-6130
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-2428
  • Fax: 215-349-5923
Mailing address:
  • Phone: 215-662-2428
  • Fax: 215-349-5923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD482803
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: