Provider Demographics
NPI:1376820704
Name:RAMAIAH, MATHAIAH (MD)
Entity Type:Individual
Prefix:
First Name:MATHAIAH
Middle Name:
Last Name:RAMAIAH
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 1:25 SUTTON PL S
Mailing Address - Street 2:12 H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2441
Mailing Address - Country:US
Mailing Address - Phone:212-751-2550
Mailing Address - Fax:212-750-6687
Practice Address - Street 1:8712 58TH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4821
Practice Address - Country:US
Practice Address - Phone:718-426-1777
Practice Address - Fax:718-426-1778
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126647207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease