Provider Demographics
NPI:1669461588
Name:RAVINUTHALA, RAVI V (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:V
Last Name:RAVINUTHALA
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 1:2925 VERNON PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2425
Mailing Address - Country:US
Mailing Address - Phone:513-751-6667
Mailing Address - Fax:513-872-4553
Practice Address - Street 1:2925 VERNON PL
Practice Address - Street 2:SUITE 100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2425
Practice Address - Country:US
Practice Address - Phone:513-751-6667
Practice Address - Fax:513-872-4553
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084651207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2490399Medicaid
OHH89251Medicare UPIN
OH2490399Medicaid