Provider Demographics
NPI:1255326310
Name:AGAH, RAMTIN (MD)
Entity Type:Individual
Prefix:
First Name:RAMTIN
Middle Name:
Last Name:AGAH
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 1:2490 HOSPITAL DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040
Mailing Address - Country:US
Mailing Address - Phone:650-962-4690
Mailing Address - Fax:650-962-4696
Practice Address - Street 1:2490 HOSPITAL DR
Practice Address - Street 2:SUITE 311
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040
Practice Address - Country:US
Practice Address - Phone:650-962-4690
Practice Address - Fax:650-962-4696
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA603971207RC0000X
CAA60397207RI0011X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24970ZMedicare ID - Type UnspecifiedGROUP ID
CAG40156Medicare UPIN
CA00A60397Medicare ID - Type Unspecified