Provider Demographics
NPI:1528388121
Name:JANAGAMA, RAVALI (MD)
Entity Type:Individual
Prefix:
First Name:RAVALI
Middle Name:
Last Name:JANAGAMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ACADEMY ST S
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3248
Mailing Address - Country:US
Mailing Address - Phone:252-209-3000
Mailing Address - Fax:252-209-3497
Practice Address - Street 1:500 ACADEMY ST S
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3248
Practice Address - Country:US
Practice Address - Phone:252-209-3000
Practice Address - Fax:252-209-3497
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01151208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics