Organization
DR.AMITABH R. RAM MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LILA EBRAHIMKHIL (OFFICE MANAGER)
(860) 228-9300
Entity
Organization
Contact information
Practice address
21 LIBERTY DR, UNIT B, HEBRON, CT 06248-1553
(860) 228-9300
(860) 228-4703
Mailing address
PO BOX 359, HEBRON, CT 06248-0359
(860) 228-9300
(860) 228-4703
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001349720
—
CT
05
—
004249802
—
CT
Enumeration date
05/23/2007
Last updated
12/03/2013
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