Provider Demographics
NPI:1831122860
Name:MANDA, RAVINDER R (MD)
Entity Type:Individual
Prefix:
First Name:RAVINDER
Middle Name:R
Last Name:MANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAVINDER
Other - Middle Name:R
Other - Last Name:MANDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:615-936-2000
Mailing Address - Fax:
Practice Address - Street 1:3601 THE VANDERBILT CLINIC
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-3011
Practice Address - Country:US
Practice Address - Phone:615-936-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37892207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3889655Medicaid
H58709Medicare UPIN
TN3718375Medicare ID - Type UnspecifiedMEDICARE GROUP
TN3889654Medicare ID - Type Unspecified