Provider Demographics
NPI:1578699328
Name:RAMANI, GAUTAM V (MD)
Entity Type:Individual
Prefix:DR
First Name:GAUTAM
Middle Name:V
Last Name:RAMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-8040
Mailing Address - Fax:443-462-3514
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1590
Practice Address - Country:US
Practice Address - Phone:410-328-7877
Practice Address - Fax:410-328-1048
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD67283207RC0000X, 207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS062-0327OtherCAREFIRST - REGIONAL
MD415225500Medicaid
MD931299-01 & 02OtherCAREFIRST - MARYLAND
MD13425188GMedicare PIN
MDS062-0327OtherCAREFIRST - REGIONAL
MDP00630497Medicare PIN
MD931299-01 & 02OtherCAREFIRST - MARYLAND