Provider Demographics
NPI:1659398089
Name:RAVURI, SUMAN (MD)
Entity Type:Individual
Prefix:
First Name:SUMAN
Middle Name:
Last Name:RAVURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 WELDON PARK DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3524
Mailing Address - Country:US
Mailing Address - Phone:718-288-8203
Mailing Address - Fax:
Practice Address - Street 1:702 WELDON PARK DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3524
Practice Address - Country:US
Practice Address - Phone:718-288-8203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043990207R00000X
NY239313207R00000X
TXN6604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001439901Medicaid
TX8FK227OtherBCBS
CT043990OtherWORK COMP
CT010043990CT01OtherBCBS #
NY239313OtherNEW YORK STATE LICENSE
NY239313OtherNEW YORK STATE LICENSE
TXI55763Medicare UPIN
CTI55763Medicare UPIN
TX264577ZPXOMedicare Oscar/Certification