Provider Demographics
NPI:1346399516
Name:TANDON, RAVI (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:
Last Name:TANDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 CASS AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4736
Mailing Address - Country:US
Mailing Address - Phone:401-768-6014
Mailing Address - Fax:877-759-9342
Practice Address - Street 1:219 CASS AVE
Practice Address - Street 2:SUITE H
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4736
Practice Address - Country:US
Practice Address - Phone:401-768-6014
Practice Address - Fax:877-759-9342
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10413207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRT35280Medicaid
RIRT35280Medicaid
RI007060293Medicare PIN