Provider Demographics
NPI:1174570311
Name:RAMASWAMY, SRIRAM (MD)
Entity type:Individual
Prefix:DR
First Name:SRIRAM
Middle Name:
Last Name:RAMASWAMY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 CALIFORNIA PLZ
Mailing Address - Street 2:CREIGHTON MEDICAL ASSOCIATES
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68178-0133
Mailing Address - Country:US
Mailing Address - Phone:402-280-5823
Mailing Address - Fax:402-280-2129
Practice Address - Street 1:3528 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-3202
Practice Address - Country:US
Practice Address - Phone:402-345-8828
Practice Address - Fax:402-345-8815
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2293174400000X
NE229332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE23726797200Medicaid
NE23726797200Medicaid
NEI34194Medicare UPIN
NE086276Medicare PIN