Provider Demographics
NPI:1710975628
Name:RAVANO, EDWIN QUIETSON (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:QUIETSON
Last Name:RAVANO
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 1:2550 MOSSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3540
Mailing Address - Country:US
Mailing Address - Phone:412-372-6120
Mailing Address - Fax:412-374-2828
Practice Address - Street 1:2550 MOSSIDE BLVD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3540
Practice Address - Country:US
Practice Address - Phone:412-372-6120
Practice Address - Fax:412-374-2828
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018912190001Medicaid
PAH69846Medicare UPIN
PAP00241625Medicare PIN
PACG1496Medicare PIN
PA0018912190001Medicaid