Provider Demographics
NPI:1417900655
Name:RAVETZ, LARRY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ALAN
Last Name:RAVETZ
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 1:595 WEST STATE STREET
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2554
Mailing Address - Country:US
Mailing Address - Phone:215-345-2885
Mailing Address - Fax:215-345-2552
Practice Address - Street 1:595 WEST STATE STREET
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2554
Practice Address - Country:US
Practice Address - Phone:215-345-2885
Practice Address - Fax:215-345-2552
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043447E207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001172636Medicaid
PA564050Medicare PIN
PA001172636Medicaid