Healthcare Provider Details

I. General information

NPI: 1528388121
Provider Name (Legal Business Name): RAVALI JANAGAMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W MAIN ST
SANFORD NC
27332-5919
US

IV. Provider business mailing address

145 W MAIN ST
SANFORD NC
27332-5919
US

V. Phone/Fax

Practice location:
  • Phone: 919-775-7337
  • Fax: 919-775-1525
Mailing address:
  • Phone: 919-775-7337
  • Fax: 919-775-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2013-01151
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: