Provider Demographics
NPI:1861475915
Name:SAMRA, RAVINDER (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVINDER
Middle Name:
Last Name:SAMRA
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 1:520 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5257
Mailing Address - Country:US
Mailing Address - Phone:509-547-7704
Mailing Address - Fax:
Practice Address - Street 1:7425 WRIGLEY DR
Practice Address - Street 2:SUITE 206
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5292
Practice Address - Country:US
Practice Address - Phone:509-546-8400
Practice Address - Fax:509-546-8391
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046983207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI160D410050OtherBLUE CROSS BLUE SHIELD
WA2002147Medicaid
MI1602503942OtherBLUE CROSS BLUE SHIELD
MI160D410050OtherCOMMUNITY BLUE
MIC7620OtherMCARE
MI0982898OtherHEALTH PLUS
MI160D410050OtherBLUE CARE NETWORK
MI160D410050OtherBLUE CHOICE
MI4392820Medicaid
MI5458749OtherAETNA
MIG74988OtherHEALTH NET FEDERAL SERVIC
MI03775572OtherCIGNA
MI1002049OtherHEALTH ADVANTAGE NETWORK
MI3477128Medicaid
MIG74988OtherHAP
MI1002049OtherMCLAREN HEALTH PLAN
MI5458749OtherAETNA