MEDICARE: DR. PAPANNA RAVICHANDRA MD

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	207R00000X	Internal Medicine Physician	212412	NY

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	:	1275602096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAPANNA RAVICHANDRA MD

Provider Business Mailing Address
First Line	:	120 E 36TH ST
Second Line	:	STE 1E
City	:	NEW YORK
State	:	NY
Zip	:	10016-3423
Country	:	US
Telephone Number	:	212-532-3333
Fax Number	:	212-532-9999

Provider Business Practice Location Address
First Line	:	120 E 36TH ST STE 1E
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-3423
Country	:	US
Telephone Number	:	212-532-3333
Fax Number	:	212-532-9999

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	05/20/2022

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