Provider Demographics
NPI:1205994936
Name:BALAJI, RAMA (MD)
Entity type:Individual
Prefix:
First Name:RAMA
Middle Name:
Last Name:BALAJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAMASUBRAMANIAM
Other - Middle Name:
Other - Last Name:VENKATABALAJI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7373 WEST LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3377
Mailing Address - Country:US
Mailing Address - Phone:209-476-5945
Mailing Address - Fax:209-476-3528
Practice Address - Street 1:7373 WEST LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3377
Practice Address - Country:US
Practice Address - Phone:209-476-5945
Practice Address - Fax:209-476-3528
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1414082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH27702Medicare UPIN