Provider Demographics
NPI:1013228980
Name:RAM, PRABHU SUDANTIRARAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:PRABHU
Middle Name:SUDANTIRARAJ
Last Name:RAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BOSTON PROVIDENCE TPKE
Mailing Address - Street 2:STE 210
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5086
Mailing Address - Country:US
Mailing Address - Phone:508-236-8360
Mailing Address - Fax:508-236-8377
Practice Address - Street 1:19 STURDY ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3152
Practice Address - Country:US
Practice Address - Phone:508-236-8360
Practice Address - Fax:508-236-8377
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.057815207R00000X, 2084P0800X
MA254585207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry