Healthcare Provider Details

I. General information

NPI: 1104021567
Provider Name (Legal Business Name): RAVICHANDRA REDDY BOYELLA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1758 PARK PL STE 401
MONTGOMERY AL
36106-1135
US

IV. Provider business mailing address

1758 PARK PL STE 401
MONTGOMERY AL
36106-1135
US

V. Phone/Fax

Practice location:
  • Phone: 334-264-9191
  • Fax:
Mailing address:
  • Phone: 334-264-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD.34827
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: