Basic Information
Provider Information
NPI: 1891711016
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HACHEM
FirstName: RAMSEY
MiddleName: RAYMOND
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 660 S EUCLID AVE
Address2: CB 8052
City: SAINT LOUIS
State: MO
PostalCode: 631101010
CountryCode: US
TelephoneNumber: 3144548917
FaxNumber: 3144545571
Practice Location
Address1: 4921 PARKVIEW PL
Address2: 8TH FL
City: SAINT LOUIS
State: MO
PostalCode: 631101032
CountryCode: US
TelephoneNumber: 3144548917
FaxNumber: 3144545571
Other Information
ProviderEnumerationDate: 07/14/2006
LastUpdateDate: 11/15/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001X2000168797MOY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

ID Information
IDTypeStateIssuerDescription
20609320505MO MEDICAID


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