Provider Demographics
NPI:1093806754
Name:SHANKAR, RAVI (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:
Last Name:SHANKAR
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 1:44215 15TH ST W STE 105
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-5503
Mailing Address - Country:US
Mailing Address - Phone:661-948-8000
Mailing Address - Fax:661-948-8029
Practice Address - Street 1:44215 15TH ST W STE 105
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5503
Practice Address - Country:US
Practice Address - Phone:661-948-8000
Practice Address - Fax:661-948-8029
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64181207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG67976Medicare UPIN
CAA64181Medicare ID - Type Unspecified