Provider Demographics
NPI:1558338194
Name:CHAVALI, RAM VSR (MD)
Entity Type:Individual
Prefix:
First Name:RAM
Middle Name:VSR
Last Name:CHAVALI
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:PO BOX 4216
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-4216
Mailing Address - Country:US
Mailing Address - Phone:717-394-6028
Mailing Address - Fax:717-509-6362
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-4900
Practice Address - Fax:717-544-5907
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4351952085N0700X
MA779852085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102202563Medicaid
MAA30533Medicare ID - Type Unspecified