Provider Demographics
NPI:1255425112
Name:RAMCHANDER, ETHIRAJ (MD)
Entity type:Individual
Prefix:
First Name:ETHIRAJ
Middle Name:
Last Name:RAMCHANDER
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:PO BOX 1739
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-1739
Mailing Address - Country:US
Mailing Address - Phone:352-365-2333
Mailing Address - Fax:352-365-2024
Practice Address - Street 1:1131 E NORTH BLVD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5375
Practice Address - Country:US
Practice Address - Phone:352-365-2333
Practice Address - Fax:352-365-2024
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075978207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43773OtherBLUE CROSS BLUE SHIELD
FL43773OtherBLUE CROSS BLUE SHIELD
FL43773XMedicare PIN