Healthcare Provider Details

I. General information

NPI: 1609885540
Provider Name (Legal Business Name): SUDHA RAMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUDHA RAVISHANKAR

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NUTT RD PHOENIXVILLE HOSPITAL
PHOENIXVILLE PA
19460-3906
US

IV. Provider business mailing address

PO BOX 191 PROVIDER ENROLLMENT DEPARTMENT
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 610-983-1000
  • Fax: 302-651-4945
Mailing address:
  • Phone: 904-697-4203
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD064672L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD064672L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: