Provider Demographics
NPI:1710175278
Name:RAMAN, RAGHAV (MD)
Entity Type:Individual
Prefix:
First Name:RAGHAV
Middle Name:
Last Name:RAMAN
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2871
Mailing Address - Fax:916-853-4730
Practice Address - Street 1:6555 COYLE AVE STE 180
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0303
Practice Address - Country:US
Practice Address - Phone:916-536-3666
Practice Address - Fax:916-536-3515
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA972502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A869820Medicaid
CA00A869820Medicaid
CAI13678Medicare UPIN