Provider Demographics
NPI:1528357852
Name:SUTARIA, RAVI BHUPATLAL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:BHUPATLAL
Last Name:SUTARIA
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 1:11203 QUEENS BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5550
Mailing Address - Country:US
Mailing Address - Phone:347-960-7501
Mailing Address - Fax:347-960-7402
Practice Address - Street 1:11203 QUEENS BLVD STE 209
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:347-960-7501
Practice Address - Fax:347-960-7402
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT053699207RR0500X
NY276084207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3972603Medicaid