Provider Demographics
NPI:1699858571
Name:BALLEM, RAMAMOHANARAO V (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMAMOHANARAO
Middle Name:V
Last Name:BALLEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:230 SHERMAN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1529
Mailing Address - Country:US
Mailing Address - Phone:973-744-8585
Mailing Address - Fax:973-748-5990
Practice Address - Street 1:230 SHERMAN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1529
Practice Address - Country:US
Practice Address - Phone:973-744-8585
Practice Address - Fax:973-748-5990
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03474100208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1839403Medicaid
NJ1839403Medicaid
NJBA534041Medicare ID - Type Unspecified