Healthcare Provider Details

I. General information

NPI: 1699976936
Provider Name (Legal Business Name): RAM PRASAD RAVI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1963 GRAND CONCOURSE FL 2
BRONX NY
10453-4995
US

IV. Provider business mailing address

71 BROADWAY APT 2G
NEW YORK NY
10006-2603
US

V. Phone/Fax

Practice location:
  • Phone: 319-335-4416
  • Fax: 319-335-4225
Mailing address:
  • Phone: 617-990-4744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number265116
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: