Provider Demographics
NPI:1134673742
Name:JAGATA, RAVALI
Entity Type:Individual
Prefix:
First Name:RAVALI
Middle Name:
Last Name:JAGATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 WESTERLEE PL
Mailing Address - Street 2:APT 1A
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3727
Mailing Address - Country:US
Mailing Address - Phone:484-949-2229
Mailing Address - Fax:
Practice Address - Street 1:1204 WESTERLEE PL
Practice Address - Street 2:APT 1A
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3727
Practice Address - Country:US
Practice Address - Phone:484-949-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP33503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine