Provider Demographics
NPI:1699972307
Name:RAMAKRISHNAN, JEEVAN B (MD)
Entity type:Individual
Prefix:DR
First Name:JEEVAN
Middle Name:B
Last Name:RAMAKRISHNAN
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 1:4600 LAKE BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7528
Mailing Address - Country:US
Mailing Address - Phone:919-787-1374
Mailing Address - Fax:919-571-8135
Practice Address - Street 1:4600 LAKE BOONE TRL
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7501
Practice Address - Country:US
Practice Address - Phone:919-787-1374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-00316207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology