Provider Demographics
NPI:1659302818
Name:RAMANAN, VENKAT SUNDARAM (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKAT
Middle Name:SUNDARAM
Last Name:RAMANAN
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 1:3575 OLD WASHINGTON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3269
Mailing Address - Country:US
Mailing Address - Phone:301-645-9650
Mailing Address - Fax:301-645-0774
Practice Address - Street 1:3575 OLD WASHINGTON RD
Practice Address - Street 2:SUITE A
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3269
Practice Address - Country:US
Practice Address - Phone:301-645-9650
Practice Address - Fax:301-645-0774
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD207703500Medicaid
MDG78030Medicare UPIN
MD666LMedicare ID - Type Unspecified