Provider Demographics
NPI:1720018740
Name:RAVREBY, WILLIAM DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAVID
Last Name:RAVREBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER BLVD
Mailing Address - Street 2:ACP-331
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3902
Mailing Address - Country:US
Mailing Address - Phone:610-874-1253
Mailing Address - Fax:610-619-8429
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:ACP-331
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-874-1253
Practice Address - Fax:610-619-8429
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2016-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD016776E207R00000X
PAMD-016776-E207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA158640PNJMedicare PIN