Provider Demographics
NPI:1144218488
Name:PATAK, RAM V (MD)
Entity Type:Individual
Prefix:DR
First Name:RAM
Middle Name:V
Last Name:PATAK
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 1:18546 ROSCOE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4667
Mailing Address - Country:US
Mailing Address - Phone:818-993-5600
Mailing Address - Fax:818-775-1509
Practice Address - Street 1:18546 ROSCOE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4667
Practice Address - Country:US
Practice Address - Phone:818-993-5600
Practice Address - Fax:818-775-1509
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2023-03-07
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-25
Provider Licenses
StateLicense IDTaxonomies
CAC39711207RN0300X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA390000081OtherMEDICARE RAILROAD
CAGR0050270Medicaid
CAGR0050270Medicaid
CAAP1363136OtherDEA
CAC35673Medicare UPIN