Provider Demographics
NPI:1063408789
Name:RAMAN, CHIDAMBARAM (MD)
Entity type:Individual
Prefix:DR
First Name:CHIDAMBARAM
Middle Name:
Last Name:RAMAN
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 283
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07451-0283
Mailing Address - Country:US
Mailing Address - Phone:201-444-4466
Mailing Address - Fax:201-444-6672
Practice Address - Street 1:1200 E RIDGEWOOD AVE
Practice Address - Street 2:WEST WING, 2ND FLOOR
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3957
Practice Address - Country:US
Practice Address - Phone:201-444-4466
Practice Address - Fax:201-444-6672
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2008-04-18
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-18
Provider Licenses
StateLicense IDTaxonomies
NJMA07530000208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC1069686Medicare PIN
NJH72650Medicare UPIN