Healthcare Provider Details

I. General information

NPI: 1699271163
Provider Name (Legal Business Name): BHARAT RAVISHANKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 SAMARITAN DR STE 845
SAN JOSE CA
95124-4110
US

IV. Provider business mailing address

2577 SAMARITAN DR STE 845
SAN JOSE CA
95124-4110
US

V. Phone/Fax

Practice location:
  • Phone: 408-610-2001
  • Fax:
Mailing address:
  • Phone: 408-610-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA200719
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA200719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: