MEDICARE: DR. ARNOLD S. RAVICK D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PO326	DC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480013906	OTHER	DC	RR MEDICARE INDIVIDUAL PROVIDER #

General Provider Information

NPI Number	:	1003870841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARNOLD S. RAVICK D.P.M.

Provider Business Mailing Address
First Line	:	1145 19TH ST NW
Second Line	:	SUITE #409
City	:	WASHINGTON
State	:	DC
Zip	:	20036-3701
Country	:	US
Telephone Number	:	301-455-3566
Fax Number	:	202-296-2531

Provider Business Practice Location Address
First Line	:	1145 19TH STREET, N.W.
Second Line	:	SUITE 409
City	:	WASHINGTON
State	:	DC
Zip	:	20036-3716
Country	:	US
Telephone Number	:	202-223-0500
Fax Number	:	202-296-2531

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	03/01/2017

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