Provider Demographics
NPI:1669472817
Name:RAVI, BHARGAVA (MD)
Entity Type:Individual
Prefix:DR
First Name:BHARGAVA
Middle Name:
Last Name:RAVI
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 1:550 PARMALEE AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1602
Mailing Address - Country:US
Mailing Address - Phone:330-743-6270
Mailing Address - Fax:330-743-6596
Practice Address - Street 1:550 PARMALEE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1602
Practice Address - Country:US
Practice Address - Phone:330-743-6270
Practice Address - Fax:330-743-6596
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-7163-R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0719262Medicaid
OH0719262Medicaid
OH9342371Medicare ID - Type Unspecified