Provider Demographics
NPI:1205838596
Name:SUBRAYA, RAVIPRASAD G (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVIPRASAD
Middle Name:G
Last Name:SUBRAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:483 N SEMORAN BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3800
Mailing Address - Country:US
Mailing Address - Phone:407-645-1847
Mailing Address - Fax:321-274-0246
Practice Address - Street 1:483 N SEMORAN BLVD
Practice Address - Street 2:STE 102
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3800
Practice Address - Country:US
Practice Address - Phone:407-645-1847
Practice Address - Fax:321-274-0246
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME91280207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1106338OtherHUMANA PROV ID #
FL271152400Medicaid
FL1131656OtherCIGNA PROV ID #
FL1949605OtherUNITED H'CARE PROV ID #
FL50058OtherBCBS OF FL PROV ID #
FL17708OtherFHHS PROV ID #
FL57215OtherAMERIGROUP MCD PROV ID #
FLP00216444OtherRAILROAD MEDICARE
FL1131656OtherCIGNA PROV ID #
FL50058OtherBCBS OF FL PROV ID #