MEDICARE: RAVI RAMSAMOOJ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician		NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00391179	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	279689	OTHER	VA	ANTHEM BLUE CROSS BLUE SH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	197180	OTHER		MEDCOST
5	137K0	OTHER	NC	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1124012406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVI RAMSAMOOJ MD

Provider Business Mailing Address
First Line	:	206 HASTINGS LN
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3324
Country	:	US
Telephone Number	:	252-335-1083
Fax Number	:	252-335-4030

Provider Business Practice Location Address
First Line	:	206 HASTINGS LN
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3324
Country	:	US
Telephone Number	:	252-335-1083
Fax Number	:	252-335-4030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	10/25/2007

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