Healthcare Provider Details

I. General information

NPI: 1700085164
Provider Name (Legal Business Name): REKHA PRIYA RAVEENDRAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 OLENTANGY RIVER RD STE 4000
COLUMBUS OH
43212-3154
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-3687
  • Fax: 614-293-9698
Mailing address:
  • Phone: 614-366-3687
  • Fax: 614-293-9698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number35.096178
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number35.096178
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number35.096178
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: