Provider Demographics
NPI:1003482621
Name:RAVANGARD, DARIA (MD)
Entity type:Individual
Prefix:DR
First Name:DARIA
Middle Name:
Last Name:RAVANGARD
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 1:52 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-9092
Mailing Address - Country:US
Mailing Address - Phone:212-466-4848
Mailing Address - Fax:212-466-4855
Practice Address - Street 1:52 W 8TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9092
Practice Address - Country:US
Practice Address - Phone:212-466-4848
Practice Address - Fax:212-466-4855
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12850207Q00000X
NY332571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine