Provider Demographics
NPI:1275720179
Name:RAVI S RANDHAWA DO PA
Entity Type:Organization
Organization Name:RAVI S RANDHAWA DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PEG
Authorized Official - Middle Name:
Authorized Official - Last Name:SADOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-638-8505
Mailing Address - Street 1:16244 S MILITARY TRL
Mailing Address - Street 2:SUITE 710
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6534
Mailing Address - Country:US
Mailing Address - Phone:561-638-8505
Mailing Address - Fax:561-638-8504
Practice Address - Street 1:16244 S MILITARY TRL
Practice Address - Street 2:SUITE 710
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6534
Practice Address - Country:US
Practice Address - Phone:561-638-8505
Practice Address - Fax:561-638-8504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007402207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG63127Medicare UPIN
FL57534Medicare PIN