Provider Demographics
NPI:1922097666
Name:RAYASAM, RAMAKUMAR VENKATA (MD,)
Entity Type:Individual
Prefix:DR
First Name:RAMAKUMAR
Middle Name:VENKATA
Last Name:RAYASAM
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:DR
Other - First Name:RAMAKUMAR
Other - Middle Name:V
Other - Last Name:RAYASAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD,
Mailing Address - Street 1:207 S 2ND ST
Mailing Address - Street 2:MORRIS PARK
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1807
Mailing Address - Country:US
Mailing Address - Phone:908-454-2279
Mailing Address - Fax:
Practice Address - Street 1:207 S 2ND ST
Practice Address - Street 2:MORRIS PARK
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1807
Practice Address - Country:US
Practice Address - Phone:908-454-2279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-16
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA03805100207YX0007X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ452235Medicare ID - Type Unspecified