Provider Demographics
NPI:1235497298
Name:MEMORIAL PHYSICIAN GROUP- CHRISTOPHER RAMSARAN, MD
Entity Type:Organization
Organization Name:MEMORIAL PHYSICIAN GROUP- CHRISTOPHER RAMSARAN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:RAMSARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-276-1330
Mailing Address - Street 1:12781 MIRAMAR PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2908
Mailing Address - Country:US
Mailing Address - Phone:954-276-1330
Mailing Address - Fax:954-276-0250
Practice Address - Street 1:12781 MIRAMAR PKWY STE 202
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2908
Practice Address - Country:US
Practice Address - Phone:954-276-1330
Practice Address - Fax:954-276-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105808207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005580000Medicaid
FL14KA2OtherBCBS