Provider Demographics
NPI:1922072321
Name:RAVRY, MARIO EURICO (MD)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:EURICO
Last Name:RAVRY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5505 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 650
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1705
Mailing Address - Country:US
Mailing Address - Phone:404-459-9340
Mailing Address - Fax:404-459-9347
Practice Address - Street 1:5505 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 650
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1705
Practice Address - Country:US
Practice Address - Phone:404-459-9340
Practice Address - Fax:404-459-9347
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA044317207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52728736OtherBLUE CROSS BLUE SHIELD
P00059607OtherRAILROAD MEDICARE
G98655Medicare UPIN
P00059607OtherRAILROAD MEDICARE