Provider Demographics
NPI:1508244609
Name:VAMSEE, RAVI (MBBS, MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:
Last Name:VAMSEE
Suffix:
Gender:M
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:RAVI
Other - Middle Name:VAMSEE
Other - Last Name:VEGULLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3900 CITY AVE APT J622
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2917
Mailing Address - Country:US
Mailing Address - Phone:609-375-7440
Mailing Address - Fax:
Practice Address - Street 1:111 MICHIGAN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2916
Practice Address - Country:US
Practice Address - Phone:609-375-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR90102080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology