Healthcare Provider Details

I. General information

NPI: 1568436434
Provider Name (Legal Business Name): RAVIPRASAD GOVIND RAO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RICHLAND MEDICAL PARK DR SUITE 400
COLUMBIA SC
29203-6849
US

IV. Provider business mailing address

54 CLIPPER WAY
COLUMBIA SC
29229
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-6392
  • Fax: 803-434-4309
Mailing address:
  • Phone: 803-699-6544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number27183
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: