Healthcare Provider Details

I. General information

NPI: 1669158309
Provider Name (Legal Business Name): RAVANANE RAMADOSAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAVANANE R MD

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT STREET
BOSTON MA
02114-2621
US

IV. Provider business mailing address

1 EMERSON PL APT 4H
BOSTON MA
02114-2205
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-4254
  • Fax:
Mailing address:
  • Phone: 617-648-2180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME183988
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number295105
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: