Provider Demographics
NPI:1477737930
Name:RAM, ASHWIN THALAGAVARA (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:ASHWIN
Middle Name:THALAGAVARA
Last Name:RAM
Suffix:
Gender:M
Credentials:MD,MPH
Other - Prefix:DR
Other - First Name:ASHWIN
Other - Middle Name:THALAGAVARA
Other - Last Name:RAMACHANDRAPPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,MPH
Mailing Address - Street 1:4722 N 24TH ST STE 150
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4860
Mailing Address - Country:US
Mailing Address - Phone:602-256-4628
Mailing Address - Fax:602-627-6325
Practice Address - Street 1:4722 N 24TH ST STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4860
Practice Address - Country:US
Practice Address - Phone:602-256-4628
Practice Address - Fax:602-627-6325
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA585782080N0001X
AZ413102080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine