MEDICARE: DR. RAVI SHANKAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician	2019-00073	NC

General Provider Information

NPI Number	:	1588665525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAVI SHANKAR MD

Provider Business Mailing Address
First Line	:	PO BOX 745040
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-5040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 3RD ST STE 200
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-6967
Country	:	US
Telephone Number	:	336-890-3255
Fax Number	:	336-890-3298

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	08/19/2021

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Directions to “ DR. RAVI SHANKAR MD” Practice Location

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