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General NPI Number Information
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NPI Number | 1427201359
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Entity Type | Individual
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Provider Name | RAVI V DHANISETTY M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 3401 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5103
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Country | US
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Telephone | 215-707-3133
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Fax | 215-707-3945
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Provider Business Mailing Address
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Address Line | 2450 W HUNTING PARK AVE 3/208N
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1302
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Country | US
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Telephone | 215-707-3133
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Fax | 215-707-3945
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | ME152784
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | MD446408
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License Number State | PA
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