Provider Demographics
NPI:1922365964
Name:RAVIPATI, CHANDANA SHILPA KOLLIPARA (DO)
Entity Type:Individual
Prefix:DR
First Name:CHANDANA SHILPA
Middle Name:KOLLIPARA
Last Name:RAVIPATI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1120 POLARIS PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-4057
Mailing Address - Country:US
Mailing Address - Phone:614-434-5431
Mailing Address - Fax:614-961-1072
Practice Address - Street 1:1120 POLARIS PKWY STE 210
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-4057
Practice Address - Country:US
Practice Address - Phone:614-434-5431
Practice Address - Fax:614-961-1072
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LADO.000446207RR0500X
OH34.014476207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0420613Medicaid