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General NPI Number Information
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NPI Number | 1003964016
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Entity Type | Organization
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Legal Business Name | ROANOKE VALLEY PSYCHIATRIC ASSOCIATES, P.A.
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 321 HIGHWAY 125
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City | ROANOKE RAPIDS
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State | NC
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Zip | 27870-6445
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Country | US
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Telephone | 252-537-8400
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Fax | 252-537-9585
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Provider Business Mailing Address
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Address Line | 321 HIGHWAY 125
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City | ROANOKE RAPIDS
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State | NC
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Zip | 27870-6445
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Country | US
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Telephone | 252-537-8400
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Fax | 252-537-9585
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAVINDER MAMEDI
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Credential | M.D.
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Telephone | 252-537-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 121198
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License Number State | NC
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