Provider Demographics
NPI:1457328106
Name:RAMADHAR, ASHWIN PERSAD (MD)
Entity Type:Individual
Prefix:
First Name:ASHWIN
Middle Name:PERSAD
Last Name:RAMADHAR
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 1:1955 W BASELINE RD
Mailing Address - Street 2:STE 113-647
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-9016
Mailing Address - Country:US
Mailing Address - Phone:480-626-4813
Mailing Address - Fax:480-445-9238
Practice Address - Street 1:1400 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4707
Practice Address - Country:US
Practice Address - Phone:480-626-4813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34318207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ947046OtherAHCCCS
I3410Medicare UPIN
Z108975Medicare PIN
AZZ141912Medicare PIN