Provider Demographics
NPI:1285029066
Name:RAVIKUMAR, SITARA (MD)
Entity Type:Individual
Prefix:MS
First Name:SITARA
Middle Name:
Last Name:RAVIKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W 98TH ST APT 1E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5501
Mailing Address - Country:US
Mailing Address - Phone:212-662-6100
Mailing Address - Fax:212-662-6101
Practice Address - Street 1:240 W 98TH ST APT 1E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5501
Practice Address - Country:US
Practice Address - Phone:212-662-6100
Practice Address - Fax:212-662-6101
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2019-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS09293801390200000X
NY297321207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program