Provider Demographics
NPI:1619924701
Name:PERUVEMBA, RAMANI (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMANI
Middle Name:
Last Name:PERUVEMBA
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 1:8400 TYSONS TRACE CT
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-6034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15200 SHADY GROVE RD
Practice Address - Street 2:302
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3218
Practice Address - Country:US
Practice Address - Phone:240-453-9182
Practice Address - Fax:240-453-9189
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD55800207L00000X
MDD0055800208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD807001600Medicaid
601285800OtherFECA
DC013472P62Medicare PIN
601285800OtherFECA
G99238Medicare UPIN
G01485F46Medicare ID - Type UnspecifiedGROUP G01485