Provider Demographics
NPI:1447406624
Name:BHALAVAT, RAVIKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:RAVIKUMAR
Middle Name:
Last Name:BHALAVAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2014 SOUTH TOLLGATE ROAD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015
Mailing Address - Country:US
Mailing Address - Phone:410-670-3076
Mailing Address - Fax:443-372-5365
Practice Address - Street 1:2014 SOUTH TOLLGATE ROAD
Practice Address - Street 2:SUITE 208
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015
Practice Address - Country:US
Practice Address - Phone:410-670-3076
Practice Address - Fax:443-372-5365
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00747902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA05216Medicaid