Provider Demographics
NPI:1619157310
Name:MALLAVARAPU, RAVI KIRAN (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:KIRAN
Last Name:MALLAVARAPU
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 1:1210 CAPSTONE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7293
Mailing Address - Country:US
Mailing Address - Phone:199-662-5619
Mailing Address - Fax:
Practice Address - Street 1:1210 CAPSTONE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7293
Practice Address - Country:US
Practice Address - Phone:919-966-2561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC84787207RN0300X
GA61484207RN0300X
NC2013-02240207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology