Provider Demographics
NPI:1750445771
Name:SUMAN CHANDRA RAVURI, MD
Entity Type:Organization
Organization Name:SUMAN CHANDRA RAVURI, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:IMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMEED
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-604-5469
Mailing Address - Street 1:912 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2822
Mailing Address - Country:US
Mailing Address - Phone:718-288-8203
Mailing Address - Fax:
Practice Address - Street 1:585 SCHENECTADY AVE
Practice Address - Street 2:SUITE D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1822
Practice Address - Country:US
Practice Address - Phone:718-604-5402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY239313OtherNEW YORK LICENSE
CT043990OtherCONNECTICUT LICENSE
CTI55763Medicare UPIN