MEDICARE: DR. JAYASHREE RAVISHANKAR 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	207RI0200X	Infectious Disease Physician	0101251651	VA
2	207RI0200X	Infectious Disease Physician	232767-1	NY
3	207RI0200X	Infectious Disease Physician	201901489	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C06778	OTHER	VA	GROUP PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649265950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAYASHREE RAVISHANKAR M.D.

Provider Business Mailing Address
First Line	:	5855 BREMO RD STE 306
Second Line	:	MOB NORTH
City	:	RICHMOND
State	:	VA
Zip	:	23226-1923
Country	:	US
Telephone Number	:	804-287-7650
Fax Number	:	804-287-7642

Provider Business Practice Location Address
First Line	:	1236 HUFFMAN MILL RD
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-8700
Country	:	US
Telephone Number	:	336-538-8760
Fax Number	:

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	09/20/2021

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