Healthcare Provider Details

I. General information

NPI: 1164555363
Provider Name (Legal Business Name): RAVI SRINIVAS SWAMY M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 WALKER LANE, SUITE 308
ALEXANDRIA VA
22310-3247
US

IV. Provider business mailing address

224 D CORNWALL STREET NW STE 403
LEESBURG VA
20176-2704
US

V. Phone/Fax

Practice location:
  • Phone: 703-313-7700
  • Fax: 703-313-0178
Mailing address:
  • Phone: 703-737-6010
  • Fax: 703-443-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA93257
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101245011
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: