Provider Demographics
NPI:1376747022
Name:RAMOS, ALBERT (OTR)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:RAMOS
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-4038
Mailing Address - Country:US
Mailing Address - Phone:610-559-1695
Mailing Address - Fax:
Practice Address - Street 1:109 S 15TH ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-4038
Practice Address - Country:US
Practice Address - Phone:610-559-1695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00266600171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46TR00266600OtherLICENSED