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NPI Code Detail

MEDICARE: PRIYANKA RAVAL

MEDICARE: PRIYANKA RAVAL
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
1207R00000XInternal Medicine Physician2011012664MO

General Provider Information

NPI Number : 1235427675
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRIYANKA RAVAL
Provider Business Mailing Address
First Line : 1120 15TH STREET
Second Line : BAA 5407
City : AUGUSTA
State : GA
Zip : 30912-3001
Country : US
Telephone Number : 706-721-2505
Fax Number :
Provider Business Practice Location Address
First Line : 6420 CLAYTON RD
Second Line : DEPARTMENT OF INTERNAL MEDICINE (SUITE #2214 )
City : SAINT LOUIS
State : MO
Zip : 63117-1811
Country : US
Telephone Number : 501-766-8875
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2011
Last Update Date : 05/27/2016

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Directions to “ PRIYANKA RAVAL ” Practice Location

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