Provider Demographics
NPI:1609829167
Name:RAJARAM, RAMACHANDRAN (MD)
Entity Type:Individual
Prefix:
First Name:RAMACHANDRAN
Middle Name:
Last Name:RAJARAM
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 1:3300 TAMIAMI TRL
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8054
Mailing Address - Country:US
Mailing Address - Phone:941-629-4676
Mailing Address - Fax:941-629-1522
Practice Address - Street 1:3300 TAMIAMI TRL
Practice Address - Street 2:SUITE 101A
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8054
Practice Address - Country:US
Practice Address - Phone:941-629-4676
Practice Address - Fax:941-629-1522
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0035578207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58298ZMedicare ID - Type Unspecified
D56922Medicare UPIN