Provider Demographics
NPI:1578651675
Name:RAMPAL, SHARAN (MD)
Entity Type:Individual
Prefix:
First Name:SHARAN
Middle Name:
Last Name:RAMPAL
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 1:60 LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-4326
Mailing Address - Country:US
Mailing Address - Phone:856-455-6711
Mailing Address - Fax:856-455-1979
Practice Address - Street 1:60 LANDIS AVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-4326
Practice Address - Country:US
Practice Address - Phone:856-455-6711
Practice Address - Fax:856-455-1979
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA037648002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0578401Medicaid
NJ028998Medicare PIN
NJC52646Medicare UPIN