Provider Demographics
NPI:1477530681
Name:RAMANATHAN, RAMESH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMESH
Middle Name:
Last Name:RAMANATHAN
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 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8029
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:1000 36TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4862
Practice Address - Country:US
Practice Address - Phone:772-567-9711
Practice Address - Fax:772-563-4574
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057155A207ZP0102X
FLME106594207ZP0102X
WI28958-020207ZP0102X
IL036.079139207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000021917OtherMPLAN
IN200418290AMedicaid
IN000000264764OtherANTHEM
FL002451600Medicaid
IN200418290AMedicaid
FLDK750ZMedicare PIN
FL002451600Medicaid
E18290Medicare UPIN