Provider Demographics
NPI:1053690313
Name:KAVUDA, RAVI RAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:RAJ
Last Name:KAVUDA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-873-1244
Practice Address - Street 1:100 JOHN ROEMMELT DR STE 203
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8303
Practice Address - Country:US
Practice Address - Phone:607-481-2059
Practice Address - Fax:607-367-5007
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2020-11-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY275585208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04019912Medicaid
PA103558078Medicaid