Provider Demographics
NPI:1861456634
Name:RAM K KAMATH M D INC.
Entity Type:Organization
Organization Name:RAM K KAMATH M D INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:760-946-4840
Mailing Address - Street 1:18564 US HIGHWAY 18
Mailing Address - Street 2:SUITE 103 & 104
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2312
Mailing Address - Country:US
Mailing Address - Phone:760-946-4840
Mailing Address - Fax:760-947-4740
Practice Address - Street 1:18564 US HIGHWAY 18
Practice Address - Street 2:SUITE 103 & 104
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2312
Practice Address - Country:US
Practice Address - Phone:760-946-4840
Practice Address - Fax:760-947-4740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46329207R00000X
CAA50460208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0086590Medicaid
CAZZZ61434ZOtherBLUE CROSS/SHIELD
CAZZZ070172Medicare PIN
CA00A463290Medicare PIN