Provider Demographics
NPI:1922075506
Name:KARANAM, RAVINDRA N (MD)
Entity Type:Individual
Prefix:
First Name:RAVINDRA
Middle Name:N
Last Name:KARANAM
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 1:201 LYONS AVE
Mailing Address - Street 2:SUITE G5
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2027
Mailing Address - Country:US
Mailing Address - Phone:973-926-7749
Mailing Address - Fax:973-923-4683
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:SUITE G5
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-7749
Practice Address - Fax:973-923-4683
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03994000208600000X, 208G00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3644103Medicaid
NJ514867PEVMedicare ID - Type Unspecified
NJ3644103Medicaid