Provider Demographics
NPI:1699725440
Name:RAMAKRISHNAN, SAMPATH K (MD)
Entity type:Individual
Prefix:DR
First Name:SAMPATH
Middle Name:K
Last Name:RAMAKRISHNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMPATH
Other - Middle Name:
Other - Last Name:RAMAKRISHNAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2970 GARDEN CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8365
Mailing Address - Country:US
Mailing Address - Phone:925-519-0409
Mailing Address - Fax:925-485-4590
Practice Address - Street 1:2970 GARDEN CREEK CIR
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8365
Practice Address - Country:US
Practice Address - Phone:925-519-0409
Practice Address - Fax:925-485-4590
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73586207R00000X
CAA 073586207QH0002X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27952ZOtherPTAN