Provider Demographics
NPI:1669660627
Name:RAVINDRAN, NISHAL CHOLAPURATH (MD)
Entity Type:Individual
Prefix:DR
First Name:NISHAL
Middle Name:CHOLAPURATH
Last Name:RAVINDRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHOLAPURATH
Other - Middle Name:NISHAL
Other - Last Name:RAVINDRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N. ACADEMY AVENUE
Mailing Address - Street 2:GEISINGER MEDICAL CENTER,
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822
Mailing Address - Country:US
Mailing Address - Phone:570-271-6201
Mailing Address - Fax:
Practice Address - Street 1:254 EASTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1766
Practice Address - Country:US
Practice Address - Phone:732-745-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT189842207R00000X
PAMD447165208M00000X
MA243282208M00000X
NJ25MA10222800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00135881301OtherUPMC ADVANTAGE HMO