Provider Demographics
NPI:1497822738
Name:SRIVASTAVA, RAVINDRA PRAKASH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVINDRA
Middle Name:PRAKASH
Last Name:SRIVASTAVA
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 1:60 MAIN ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-6602
Mailing Address - Country:US
Mailing Address - Phone:843-681-1935
Mailing Address - Fax:
Practice Address - Street 1:25 HOSPITAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2738
Practice Address - Country:US
Practice Address - Phone:843-784-8224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC236892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC236890Medicaid
SC7637Medicare ID - Type UnspecifiedMEDICARE
SC236890Medicaid
SCAA90237652Medicare PIN