Provider Demographics
NPI:1437415684
Name:RAVIN, REID A (MD)
Entity Type:Individual
Prefix:
First Name:REID
Middle Name:A
Last Name:RAVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4755 OGLETOWN STANTON RD STE 1E20
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19718-2200
Mailing Address - Country:US
Mailing Address - Phone:302-733-5700
Mailing Address - Fax:302-733-5775
Practice Address - Street 1:4755 OGLETOWN STANTON RD STE 1E20
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-5700
Practice Address - Fax:302-733-5775
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2020-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2736452086S0129X
NY273645-12086S0129X
DEC1-00136392086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery