Provider Demographics
NPI:1114921665
Name:PASSI, RAVI (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:
Last Name:PASSI
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:PO BOX 10067
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20898-0067
Mailing Address - Country:US
Mailing Address - Phone:301-527-1650
Mailing Address - Fax:301-527-8752
Practice Address - Street 1:15245 SHADY GROVE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3222
Practice Address - Country:US
Practice Address - Phone:301-527-1650
Practice Address - Fax:301-527-8752
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0028656207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD329231200Medicaid
000B01R26Medicare ID - Type Unspecified
MD329231200Medicaid