Provider Demographics
NPI:1558329201
Name:PONNAPPAN, RAVI KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:KUMAR
Last Name:PONNAPPAN
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 1:750 ROUTE 73 SOUTH
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-5343
Mailing Address - Country:US
Mailing Address - Phone:609-601-4920
Mailing Address - Fax:609-601-4921
Practice Address - Street 1:750 ROUTE 73 SOUTH
Practice Address - Street 2:SUITE 301
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-5343
Practice Address - Country:US
Practice Address - Phone:609-601-4920
Practice Address - Fax:609-601-4921
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08240900207XS0117X
PAMD432716207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ113355PFCMedicare PIN
NJP00452796Medicare PIN