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General NPI Number Information
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NPI Number | 1417154451
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Entity Type | Individual
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Provider Name | MALLESWARI S RAVI M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 12/20/2020
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Provider Practice Location Address
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Address Line | 653-1 WEST 8TH STREET 2ND FLOOR, LRC L14
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City | JACKSONVILLE
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State | FL
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Zip | 32209
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Country | US
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Telephone | 904-244-3702
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 44008 SUITE 304
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City | JACKSONVILLE
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State | FL
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Zip | 32231-4008
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Country | US
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Telephone | 904-244-2120
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Fax | 904-244-3425
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME104972
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME104972
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME104972
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License Number State | FL
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