Provider Demographics
NPI:1326077520
Name:RAVI, SASIKALA (MD)
Entity Type:Individual
Prefix:DR
First Name:SASIKALA
Middle Name:
Last Name:RAVI
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 1:160 MAIN STREET, WERNERSVILLE STATE HOSPITAL
Mailing Address - Street 2:POST BOX # 300
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565-0300
Mailing Address - Country:US
Mailing Address - Phone:610-678-3411
Mailing Address - Fax:
Practice Address - Street 1:160 MAIN STREET, WERNERSVILLE STATE HOSPITAL
Practice Address - Street 2:POST BOX # 300
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-0300
Practice Address - Country:US
Practice Address - Phone:610-678-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070253L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH36850Medicare UPIN
PA085962KKAMedicare ID - Type UnspecifiedPSYCHIATRY