Provider Demographics
NPI:1033464243
Name:RAMASAMY, BALAJI (MD)
Entity Type:Individual
Prefix:DR
First Name:BALAJI
Middle Name:
Last Name:RAMASAMY
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 1:5870 HIATUS RD
Mailing Address - Street 2:REGIONAL ADMIN OFFICE PE WEST
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2317
Mailing Address - Country:US
Mailing Address - Phone:844-453-0046
Mailing Address - Fax:865-560-7110
Practice Address - Street 1:3186 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2317
Practice Address - Country:US
Practice Address - Phone:702-731-8211
Practice Address - Fax:702-731-8201
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16895207R00000X
CAA136725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine