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General NPI Number Information
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NPI Number | 1215148051
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Entity Type | Organization
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Legal Business Name | RAVI PHYSICIAN PC
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 03/25/2010
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Provider Practice Location Address
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Address Line | 423 E 138TH ST
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City | BRONX
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State | NY
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Zip | 10454-3041
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Country | US
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Telephone | 718-292-6144
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Fax |
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Provider Business Mailing Address
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Address Line | 423 E 138TH ST SUITE 201
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City | BRONX
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State | NY
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Zip | 10454-3041
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Country | US
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Telephone | 718-292-6144
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VENKATA RAMANA RAVI
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Credential | M.D
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Telephone | 718-292-6144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 205374
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License Number State | NY
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