Provider Demographics
NPI:1679005797
Name:RAVISHANKAR, KARAN (MD)
Entity Type:Individual
Prefix:
First Name:KARAN
Middle Name:
Last Name:RAVISHANKAR
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 1:100 E LANCASTER AVE STE 256
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3432
Mailing Address - Country:US
Mailing Address - Phone:484-572-6300
Mailing Address - Fax:484-572-6305
Practice Address - Street 1:100 E LANCASTER AVE STE 256
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3432
Practice Address - Country:US
Practice Address - Phone:484-572-6300
Practice Address - Fax:484-572-6305
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63936390200000X
PAMD4723952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program