Provider Demographics
NPI:1346289048
Name:RAVI, VENKATA RAMANA (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:RAMANA
Last Name:RAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VENKATA
Other - Middle Name:RAMANA
Other - Last Name:RAVI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:19 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:TOWACO
Mailing Address - State:NJ
Mailing Address - Zip Code:07082-1283
Mailing Address - Country:US
Mailing Address - Phone:973-265-4460
Mailing Address - Fax:
Practice Address - Street 1:423 E 138TH ST
Practice Address - Street 2:SUITE # 201
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-3041
Practice Address - Country:US
Practice Address - Phone:718-292-6144
Practice Address - Fax:718-292-6124
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07863500207Q00000X
NY205374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01935955Medicaid
NJ0096156Medicaid
NYG62993Medicare UPIN
NJ093013Medicare ID - Type Unspecified
NY33V321Medicare ID - Type Unspecified