Provider Demographics
NPI:1942225883
Name:PALANIYANDI, RAVINDRAN BALAMBAL (MD)
Entity Type:Individual
Prefix:
First Name:RAVINDRAN
Middle Name:BALAMBAL
Last Name:PALANIYANDI
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 1:6513 RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-7404
Mailing Address - Country:US
Mailing Address - Phone:321-269-4464
Mailing Address - Fax:
Practice Address - Street 1:7139 NORTH HIGHWAY US # 1
Practice Address - Street 2:
Practice Address - City:PORT ST JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-5094
Practice Address - Country:US
Practice Address - Phone:321-635-8304
Practice Address - Fax:321-635-8252
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055762207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060024950OtherRAILROAD MEDICARE
FL061629000Medicaid
FLB34649Medicare UPIN
FL061629000Medicaid