MEDICARE: RAVI K. MAREEDU M.D.

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	207RC0000X	Cardiovascular Disease Physician	ME161515	FL
2	207RI0011X	Interventional Cardiology Physician	ME161515	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033303532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVI K. MAREEDU M.D.

Provider Business Mailing Address
First Line	:	PO BOX 746652
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6652
Country	:	US
Telephone Number	:	904-202-2092
Fax Number	:	904-376-4075

Provider Business Practice Location Address
First Line	:	14534 OLD SAINT AUGUSTINE RD STE 3420
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-2645
Country	:	US
Telephone Number	:	904-493-8001
Fax Number	:	904-376-3207

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

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	12/11/2024

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Directions to “ RAVI K. MAREEDU M.D.” Practice Location

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