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General NPI Number Information
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NPI Number | 1730156993
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Entity Type | Individual
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Provider Name | RAVISANKAR R BOLLA MD
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Gender | Male
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 20455 LORAIN RD SECOND FLOOR
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City | FAIRVIEW PARK
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State | OH
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Zip | 44126-3494
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Country | US
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Telephone | 440-333-8600
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Fax | 440-333-5015
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Provider Business Mailing Address
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Address Line | 6000 W CREEK RD STE 10
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City | INDEPENDENCE
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State | OH
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Zip | 44131-2139
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Country | US
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Telephone | 800-223-2273
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Fax |
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35059503B
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 35059503
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License Number State | OH
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