Provider Demographics
NPI:1649557851
Name:MENON, RAVI S (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:S
Last Name:MENON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:RAVISANKAR
Other - Middle Name:
Other - Last Name:ELAYIDATHINGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1101
Mailing Address - Country:US
Mailing Address - Phone:508-634-5026
Mailing Address - Fax:508-634-5055
Practice Address - Street 1:101 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1101
Practice Address - Country:US
Practice Address - Phone:508-634-5026
Practice Address - Fax:508-634-5055
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPERMIT390200000X
MA292434207R00000X
VA0101252069207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program