Provider Demographics
NPI:1982681417
Name:BALARAVI, BHAVANI (MD)
Entity Type:Individual
Prefix:DR
First Name:BHAVANI
Middle Name:
Last Name:BALARAVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ASHVILLE AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8682
Mailing Address - Country:US
Mailing Address - Phone:919-851-6901
Mailing Address - Fax:919-851-9354
Practice Address - Street 1:300 ASHVILLE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8682
Practice Address - Country:US
Practice Address - Phone:919-851-6901
Practice Address - Fax:919-851-9354
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44906207RC0000X
NC2008-01670207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911146Medicaid
MN092897600Medicaid
NC20223417OtherMEDICARE
MNH59787Medicare UPIN
NC20223417OtherMEDICARE