Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | MA03805100 | NJ |
NPI | 1922097666 |
---|---|
Provider Name | Dr. Ramakumar Venkata Rayasam |
First Address | Phillipsburg, NJ 08865-1807 |
Second Address | Phillipsburg, NJ 08865-1807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2005 |
Last Update Date | 08/08/2012 |