Basic Information
| Provider Information | |||||||||
| NPI: | 1275196800 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAGAM | ||||||||
| FirstName: | RADHIKA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1025 WALNUT ST STE 1100 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159551416 | ||||||||
| FaxNumber: | 2159231884 | ||||||||
| Practice Location | |||||||||
| Address1: | 833 CHESTNUT ST STE 703 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159551000 | ||||||||
| FaxNumber: | 2155032066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2019 | ||||||||
| LastUpdateDate: | 06/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208800000X | MT218749 | PA | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.