Provider Demographics
NPI:1912385147
Name:SUMAN C RAVURI MD PA
Entity Type:Organization
Organization Name:SUMAN C RAVURI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUMAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAVURI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:718-288-8203
Mailing Address - Street 1:702 WELDON PARK DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3524
Mailing Address - Country:US
Mailing Address - Phone:718-288-8203
Mailing Address - Fax:
Practice Address - Street 1:1317 LAKE POINTE PKWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3997
Practice Address - Country:US
Practice Address - Phone:718-288-8203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty