Provider Demographics
NPI:1053319129
Name:RAGOOWANSI, ASHVIN T (MD)
Entity Type:Individual
Prefix:
First Name:ASHVIN
Middle Name:T
Last Name:RAGOOWANSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 COX RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3453
Mailing Address - Country:US
Mailing Address - Phone:704-852-3888
Mailing Address - Fax:704-852-4456
Practice Address - Street 1:811 COX RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3453
Practice Address - Country:US
Practice Address - Phone:704-852-3888
Practice Address - Fax:704-852-4456
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050194L207T00000X
NC2016-01599207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010808Medicaid
PA0014211140001Medicaid
PA0014211140004Medicaid
PAF20637Medicare UPIN
PA0014211140004Medicaid
PAP00452726Medicare PIN
PA0014211140001Medicaid
OH0306903Medicare PIN