Provider Demographics
NPI:1659387132
Name:RAVINDRAN, DYANESH BAPU G (MD)
Entity Type:Individual
Prefix:
First Name:DYANESH BAPU
Middle Name:G
Last Name:RAVINDRAN
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 1:310 HARTNELL AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1800
Mailing Address - Country:US
Mailing Address - Phone:530-245-2900
Mailing Address - Fax:
Practice Address - Street 1:310 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1800
Practice Address - Country:US
Practice Address - Phone:530-245-2900
Practice Address - Fax:530-221-1583
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4204207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G0570OtherBC/BS
TX152185801Medicaid
G69218Medicare UPIN
8283B6Medicare ID - Type UnspecifiedPERFORMING PROVIDER NUMBE
TX8G0570OtherBC/BS