| Ravi Physician Pc | |
|
423 E 138th St Bronx NY 10454-3041 | |
| (718) 292-6144 | |
| Not Available |
| Full Name | Ravi Physician Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 423 E 138th St, Bronx, New York |
| Authorized Official Name and Position | Venkata Ramana Ravi (PRESIDENT) |
| Authorized Official Contact | 7182926144 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ravi Physician Pc 423 E 138th St Suite 201 Bronx NY 10454-3041 Ph: (718) 292-6144 | Ravi Physician Pc 423 E 138th St Bronx NY 10454-3041 Ph: (718) 292-6144 |
| NPI Number | 1215148051 |
|---|---|
| Provider Enumeration Date | 05/24/2007 |
| Last Update Date | 03/25/2010 |
| Medicare PECOS PAC ID | 3577556430 |
|---|---|
| Medicare Enrollment ID | O20050809000083 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215148051 | NPI | - | NPPES |
| 0096156 | Medicaid | NJ | |
| 01935955 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 205374 (New York) | Primary |
| Provider Name | Venkata R Ravi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346289048 PECOS PAC ID: 4789677659 Enrollment ID: I20050809000100 |
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