Provider Demographics
NPI:1942649710
Name:SATCHI, RAMANAN ROM (MD)
Entity Type:Individual
Prefix:MR
First Name:RAMANAN
Middle Name:ROM
Last Name:SATCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:RAMANAN
Other - Middle Name:
Other - Last Name:SATCHIDANANTHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4575 DEAN MARTIN DR UNIT 2411
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-8210
Mailing Address - Country:US
Mailing Address - Phone:212-641-0312
Mailing Address - Fax:
Practice Address - Street 1:6850 N DURANGO DR STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4596
Practice Address - Country:US
Practice Address - Phone:702-944-4028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2021-02-18
Deactivation Date:2014-04-03
Deactivation Code:
Reactivation Date:2014-07-31
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125064085208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program