MEDICARE: PRATHIBA RAM M.D.

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	2084F0202X	Forensic Psychiatry Physician	40211	KY
2	2084P0804X	Child & Adolescent Psychiatry Physician	40211	KY
3	2084P0800X	Psychiatry Physician	40211	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588754220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRATHIBA RAM M.D.

Provider Business Mailing Address
First Line	:	202 W 7TH ST
Second Line	:	SUITE 113
City	:	LONDON
State	:	KY
Zip	:	40741-1763
Country	:	US
Telephone Number	:	606-864-0510
Fax Number	:	606-864-0512

Provider Business Practice Location Address
First Line	:	202 W 7TH ST
Second Line	:	SUITE 113
City	:	LONDON
State	:	KY
Zip	:	40741-1763
Country	:	US
Telephone Number	:	606-864-0510
Fax Number	:	606-864-0512

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	01/26/2010

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