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General NPI Number Information
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NPI Number | 1730399379
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Entity Type | Organization
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Legal Business Name | DR.AMITABH R. RAM MD LLC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 21 LIBERTY DR UNIT B
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City | HEBRON
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State | CT
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Zip | 06248-1553
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Country | US
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Telephone | 860-228-9300
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Fax | 860-228-4703
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Provider Business Mailing Address
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Address Line | PO BOX 359
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City | HEBRON
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State | CT
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Zip | 06248-0359
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Country | US
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Telephone | 860-228-9300
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Fax | 860-228-4703
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. LILA EBRAHIMKHIL
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Credential |
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Telephone | 860-228-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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