Provider Demographics
NPI:1417955501
Name:SHANKAR, RAVI RAMALINGAM (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:RAMALINGAM
Last Name:SHANKAR
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:PO BOX 598
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-0598
Mailing Address - Country:US
Mailing Address - Phone:412-622-4314
Mailing Address - Fax:412-622-4882
Practice Address - Street 1:1220 LINCOLN WAY STE 102
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-1642
Practice Address - Country:US
Practice Address - Phone:412-673-0502
Practice Address - Fax:412-673-0258
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068260L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1814210000Medicaid
PA0018142100003Medicaid
PA038640Medicare ID - Type Unspecified