Basic Information
Provider Information
NPI: 1023210945
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALAM
FirstName: RAMMY
MiddleName: IHSAN
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2730 UNIVERSITY BLVD SUITE 104
Address2:  
City: WHEATON
State: MD
PostalCode: 209021979
CountryCode: US
TelephoneNumber: 3019428799
FaxNumber: 3019338554
Practice Location
Address1: 2730 UNIVERSITY BLVD
Address2: SUITE 104
City: WHEATON
State: MD
PostalCode: 209021979
CountryCode: US
TelephoneNumber: 3019428799
FaxNumber: 3019338554
Other Information
ProviderEnumerationDate: 06/04/2007
LastUpdateDate: 06/03/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XH70799MDY Allopathic & Osteopathic PhysiciansAnesthesiology 
207L00000XOT011574PAN Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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