Provider Demographics
NPI:1467425876
Name:IYER, RAVI R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:R
Last Name:IYER
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 1:224-D CORNWALL STREET, NW, SUITE 403
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:13505 DULLES TECHNOLOGY DRIVE, SUITE 1A
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-3403
Practice Address - Country:US
Practice Address - Phone:703-404-5900
Practice Address - Fax:703-421-1099
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1467425876Medicaid
VA110202110OtherRAILROAD PIN
VA30015397260001Medicaid
VAG26072Medicare UPIN
DC00P82N49Medicare PIN
VA11000769Medicare PIN
DC23738ZBTPMedicare PIN