Provider Demographics
NPI:1275526352
Name:ALAM, RAMAMURTHY N (MD)
Entity Type:Individual
Prefix:
First Name:RAMAMURTHY
Middle Name:N
Last Name:ALAM
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 1:1910 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6618
Mailing Address - Country:US
Mailing Address - Phone:330-399-7749
Mailing Address - Fax:330-399-7836
Practice Address - Street 1:1910 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6618
Practice Address - Country:US
Practice Address - Phone:330-399-7749
Practice Address - Fax:330-399-7836
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2015-10-20
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
OH35-04-0485207R00000X
OH35040485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0479412Medicare PIN