Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 25MA08165800 | NJ |
N | 2080P0214X | Pediatric Pulmonologist | D58018 | MD |
NPI | 1699710137 |
---|---|
Provider Name | Maya Ramagopal |
First Address | Red Bank, NJ 07701 |
Second Address | New Brunswick, NJ 08903-0019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 23/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0122491 | (05) | NJ |
894100900 | (05) | MD |
H73227 | (02) |