Provider Demographics
NPI:1689779118
Name:RAVI MEHRA MD, P.C.
Entity Type:Organization
Organization Name:RAVI MEHRA MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-966-8878
Mailing Address - Street 1:10000 WATSON RD
Mailing Address - Street 2:STE 2-L-13
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1854
Mailing Address - Country:US
Mailing Address - Phone:314-966-8878
Mailing Address - Fax:314-966-6065
Practice Address - Street 1:10000 WATSON RD
Practice Address - Street 2:STE 2-L-13
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1854
Practice Address - Country:US
Practice Address - Phone:314-966-8878
Practice Address - Fax:314-966-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO33143207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty