Healthcare Provider Details

I. General information

NPI: 1447229281
Provider Name (Legal Business Name): RAVI PASSI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 10/07/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15245 SHADY GROVE RD SUITE 130
ROCKVILLE MD
20850-3222
US

IV. Provider business mailing address

PO BOX 10067
GAITHERSBURG MD
20898-0067
US

V. Phone/Fax

Practice location:
  • Phone: 301-527-1650
  • Fax: 301-527-8752
Mailing address:
  • Phone: 301-527-1650
  • Fax: 301-527-8752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: RAVI PASSI
Title or Position: PRESIDENT
Credential: MD
Phone: 301-527-1650