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General NPI Number Information
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NPI Number | 1588826929
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Entity Type | Organization
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Legal Business Name | RAVI K TITHA MD PC
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 10/24/2008
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Provider Practice Location Address
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Address Line | 3150 CLINCH ST
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City | RICHLANDS
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State | VA
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Zip | 24641-2172
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Country | US
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Telephone | 276-964-6711
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Fax | 276-964-2240
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Provider Business Mailing Address
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Address Line | 3150 CLINCH ST
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City | RICHLANDS
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State | VA
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Zip | 24641-2172
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Country | US
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Telephone | 276-964-6711
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Fax | 276-964-2240
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RAVI K TITHA
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Credential | MD
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Telephone | 276-964-6711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0101235493
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License Number State | VA
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