Provider Demographics
NPI:1598798043
Name:DARAM, VASUKI S (MD)
Entity Type:Individual
Prefix:
First Name:VASUKI
Middle Name:S
Last Name:DARAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VASUKI
Other - Middle Name:S
Other - Last Name:SITTAMPALAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7007
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-7007
Mailing Address - Country:US
Mailing Address - Phone:661-726-3800
Mailing Address - Fax:661-726-3862
Practice Address - Street 1:38209 47TH ST E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-3113
Practice Address - Country:US
Practice Address - Phone:661-726-3800
Practice Address - Fax:661-726-3862
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53941FMedicaid
CAGR0021672Medicaid
FLP01548578OtherRR MEDICARE
FL013558800Medicaid
CAA93866OtherSTATE LICENSE
CAGR0021672Medicaid
CAA93866OtherSTATE LICENSE