Healthcare Provider Details

I. General information

NPI: 1497877377
Provider Name (Legal Business Name): RAVIKUMAR SINGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GRAYS HARBOR COMMUNITY HOSPITAL 915 ANDERSON DRIVE
ABERDEEN WA
98520
US

IV. Provider business mailing address

245 ST HELENS AVE # 108
TACOMA WA
98402-2594
US

V. Phone/Fax

Practice location:
  • Phone: 360-532-8330
  • Fax:
Mailing address:
  • Phone: 901-218-3035
  • Fax: 855-292-0966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-5283
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD61030731
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD43771
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE5283
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: