Provider Demographics
NPI:1558452482
Name:TITHA, RAVI KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:KUMAR
Last Name:TITHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3150 CLINCH STREET SUITE 204
Mailing Address - Street 2:WASHINGTON SQUARE CLINIC
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641
Mailing Address - Country:US
Mailing Address - Phone:276-964-6711
Mailing Address - Fax:276-964-2240
Practice Address - Street 1:3150 CLINCH STREET SUITE 204
Practice Address - Street 2:WASHINGTON SQUARE CLINIC
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641
Practice Address - Country:US
Practice Address - Phone:276-964-6711
Practice Address - Fax:276-964-2240
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101235493207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA164419OtherBLUE CROSS BLUE SHIELD
010163800OtherFEDERAL BLACK LUNG
010163800OtherFEDERAL BLACK LUNG