Provider Demographics
NPI:1245686898
Name:RAM, SATHYA (MD)
Entity type:Individual
Prefix:
First Name:SATHYA
Middle Name:
Last Name:RAM
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 1:275 MEMORIAL DR SE UNIT 310
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-2167
Mailing Address - Country:US
Mailing Address - Phone:240-715-7990
Mailing Address - Fax:
Practice Address - Street 1:676 N SAINT CLAIR ST STE 800
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2978
Practice Address - Country:US
Practice Address - Phone:312-695-5753
Practice Address - Fax:312-695-5645
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA956972085R0202X
PAMD466052208D00000X
IL0361681122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD466052OtherPA MEDICAL LICENSE