Provider Demographics
NPI:1962502658
Name:SUGUMARAN, RAMASAMY T (MD)
Entity Type:Individual
Prefix:
First Name:RAMASAMY
Middle Name:T
Last Name:SUGUMARAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6251 GOOD SAMARITAN WAY
Mailing Address - Street 2:SUITE 210 B
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-5253
Mailing Address - Country:US
Mailing Address - Phone:937-233-2055
Mailing Address - Fax:937-233-5479
Practice Address - Street 1:6251 GOOD SAMARITAN WAY
Practice Address - Street 2:SUITE 210 B
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-5253
Practice Address - Country:US
Practice Address - Phone:937-233-2055
Practice Address - Fax:937-233-5479
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-042664207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0372878Medicaid
OH0451916Medicare PIN
OHA77762Medicare UPIN
OH0451915Medicare PIN
OHRA0451913Medicare ID - Type Unspecified