Healthcare Provider Details

I. General information

NPI: 1417533118
Provider Name (Legal Business Name): RAVIVARMA SAGIRAJU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 ROUTE 100 STE 200
MACUNGIE PA
18062-9600
US

IV. Provider business mailing address

2550 ROUTE 100 STE 200
MACUNGIE PA
18062-9600
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-5210
  • Fax:
Mailing address:
  • Phone: 484-526-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberMD490643
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: