Provider Demographics
NPI:1477546778
Name:R B RAVI MD INC
Entity Type:Organization
Organization Name:R B RAVI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVEENDRA
Authorized Official - Middle Name:BABU
Authorized Official - Last Name:RAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-997-0092
Mailing Address - Street 1:2421 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-4953
Mailing Address - Country:US
Mailing Address - Phone:440-997-0092
Mailing Address - Fax:440-997-0093
Practice Address - Street 1:2421 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-4953
Practice Address - Country:US
Practice Address - Phone:440-997-0092
Practice Address - Fax:440-997-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041646R208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0431143Medicaid
DG1459OtherRR MEDICARE
=========00OtherBWC
DG1459OtherRR MEDICARE
9206213Medicare PIN