Provider Demographics
NPI:1588826929
Name:RAVI K TITHA MD PC
Entity Type:Organization
Organization Name:RAVI K TITHA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:K
Authorized Official - Last Name:TITHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-964-6711
Mailing Address - Street 1:3150 CLINCH ST
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2172
Mailing Address - Country:US
Mailing Address - Phone:276-964-6711
Mailing Address - Fax:276-964-2240
Practice Address - Street 1:3150 CLINCH ST
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2172
Practice Address - Country:US
Practice Address - Phone:276-964-6711
Practice Address - Fax:276-964-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235493261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010063671Medicaid
VA010163800OtherFEDERAL BLACK LUNG
VA164419OtherBLUECROSS BLUESHEILD
VA010063671Medicaid
VAC10569Medicare PIN