Provider Demographics
NPI:1962818476
Name:EDARA, RAVI SANKAR REDDY
Entity Type:Individual
Prefix:
First Name:RAVI SANKAR REDDY
Middle Name:
Last Name:EDARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 ROLLINGSGATE CT APT C2
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-7710
Mailing Address - Country:US
Mailing Address - Phone:860-595-7530
Mailing Address - Fax:
Practice Address - Street 1:406 ROLLINGSGATE CT APT C2
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-7710
Practice Address - Country:US
Practice Address - Phone:860-595-7530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT206091207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine