Provider Demographics
NPI:1720284425
Name:RAMASAMY, RENGARAJU (MD)
Entity type:Individual
Prefix:DR
First Name:RENGARAJU
Middle Name:
Last Name:RAMASAMY
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 1:850 GOVERNOR CARLOS CAMACHO ROAD
Mailing Address - Street 2:
Mailing Address - City:OKA TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3128
Mailing Address - Country:US
Mailing Address - Phone:671-647-2418
Mailing Address - Fax:671-649-5508
Practice Address - Street 1:850 GOVERNOR CARLOS CAMACHO ROAD
Practice Address - Street 2:
Practice Address - City:OKA TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3128
Practice Address - Country:US
Practice Address - Phone:671-647-2418
Practice Address - Fax:671-649-5508
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM001418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
56691OtherPIN
56691OtherPIN