Healthcare Provider Details

I. General information

NPI: 1235493693
Provider Name (Legal Business Name): ROHIT B RAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROHIT B RAMANATHAN MD

II. Dates (important events)

Enumeration Date: 07/01/2012
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5295 S COMMERCE DR STE 550
MURRAY UT
84107-4736
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 801-313-4110
  • Fax: 801-313-4128
Mailing address:
  • Phone: 801-313-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberBP10042444
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number12734225-1205
License Number StateUT

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: