MEDICARE: JOSEPH RAVALESE 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	2085R0001X	Radiation Oncology Physician	039160	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010039160CT01	OTHER	CT	ANTHEM BCBS
2	OV7350	OTHER	CT	PHS/HEALTHNET
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	039160	OTHER	CT	CONNECTICARE
5	P2354315	OTHER	CT	OXFORD

General Provider Information

NPI Number	:	1376505081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH RAVALESE MD

Provider Business Mailing Address
First Line	:	25 NEWELL RD STE C11
Second Line	:
City	:	BRISTOL
State	:	CT
Zip	:	06010-5140
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 NEWELL RD STE C11
Second Line	:
City	:	BRISTOL
State	:	CT
Zip	:	06010-5140
Country	:	US
Telephone Number	:	860-582-9800
Fax Number	:	203-575-5992

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	04/16/2026

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