Provider Demographics
NPI:1922264431
Name:DHARAMRAJ INC
Entity Type:Organization
Organization Name:DHARAMRAJ INC
Other - Org Name:KENNETH S. DHARAMRAJ, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-844-5404
Mailing Address - Street 1:1831 N BELCHER RD
Mailing Address - Street 2:SUITE B - 3
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1449
Mailing Address - Country:US
Mailing Address - Phone:727-796-3966
Mailing Address - Fax:727-796-3704
Practice Address - Street 1:1831 N BELCHER RD
Practice Address - Street 2:SUITE B - 3
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1449
Practice Address - Country:US
Practice Address - Phone:727-797-3966
Practice Address - Fax:727-796-3704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040027207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048685000Medicaid
FL048685000Medicaid
FL35200Medicare PIN
FL35200AMedicare PIN