Provider Demographics
NPI:1952474959
Name:GOYAL, RAMA (MD PA)
Entity Type:Individual
Prefix:MRS
First Name:RAMA
Middle Name:
Last Name:GOYAL
Suffix:
Gender:F
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-0390
Mailing Address - Country:US
Mailing Address - Phone:860-271-4700
Mailing Address - Fax:860-271-4797
Practice Address - Street 1:113 SALEM TPKE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-6484
Practice Address - Country:US
Practice Address - Phone:860-271-4700
Practice Address - Fax:860-271-4797
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0231702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F18178Medicare UPIN
CTD400007400Medicare PIN
CT260003751Medicare ID - Type UnspecifiedFIRST COAST