Provider Demographics
NPI:1295724938
Name:RAM V.RAYASAM.M.D.P.A
Entity type:Organization
Organization Name:RAM V.RAYASAM.M.D.P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMAKUMAR
Authorized Official - Middle Name:VENKATA
Authorized Official - Last Name:RAYASAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:908-454-2279
Mailing Address - Street 1:207 S 2ND ST
Mailing Address - Street 2:MORRISPARK
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1807
Mailing Address - Country:US
Mailing Address - Phone:908-454-2279
Mailing Address - Fax:908-454-5404
Practice Address - Street 1:207 S 2ND ST
Practice Address - Street 2:MORRISPARK
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1807
Practice Address - Country:US
Practice Address - Phone:908-454-2279
Practice Address - Fax:908-454-5404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA38051261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center