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General NPI Number Information
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NPI Number | 1972384196
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Entity Type | Individual
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Provider Name | PRIYANKA RAVI MD,FRCPC
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Gender | Female
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 1402 S GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1004
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Country | US
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Telephone | 314-417-9510
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Fax |
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Provider Business Mailing Address
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Address Line | 1716 KENMONT RD
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1022
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Country | US
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Telephone | 314-417-9510
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 2023012592
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License Number State | MO
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