Provider Demographics
NPI:1003874405
Name:RAVI, BALA KRISHNA BABJI (MD)
Entity Type:Individual
Prefix:DR
First Name:BALA
Middle Name:KRISHNA BABJI
Last Name:RAVI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:374 STOCKHOLM ST
Mailing Address - Street 2:C/O FACULTY PRACTICE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4006
Mailing Address - Country:US
Mailing Address - Phone:718-963-6551
Mailing Address - Fax:718-963-6793
Practice Address - Street 1:374 STOCKHOLM ST
Practice Address - Street 2:C/O FACULTY PRACTICE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4006
Practice Address - Country:US
Practice Address - Phone:718-963-6551
Practice Address - Fax:718-963-6793
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2016-09-14
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Provider Licenses
StateLicense IDTaxonomies
NY203725207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01668097Medicaid
NMG34489Medicare UPIN
NY01668097Medicaid