Provider Demographics
NPI:1194796821
Name:RAMASAMY, MUTHU M (MD, FRCS)
Entity type:Individual
Prefix:DR
First Name:MUTHU
Middle Name:M
Last Name:RAMASAMY
Suffix:
Gender:M
Credentials:MD, FRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ATWELL RD
Mailing Address - Street 2:DEPARTMENT OF SURGERY, BASSETT HEALTHCARE
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1301
Mailing Address - Country:US
Mailing Address - Phone:607-547-7835
Mailing Address - Fax:607-547-8740
Practice Address - Street 1:21 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1394
Practice Address - Country:US
Practice Address - Phone:607-547-7835
Practice Address - Fax:607-547-8740
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238263261QP3300X, 2081S0010X, 208100000X, 208VP0014X, 2081P2900X, 2081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
189053OtherBLUE CROSS
MO206000622Medicaid
189053OtherBLUE CROSS
MO956114666Medicare ID - Type UnspecifiedMEDICARE-FARMINGTON
MO206000622Medicaid