Provider Demographics
NPI:1013136605
Name:VELURI, RAVI K (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:K
Last Name:VELURI
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 1:4810 BEAUREGARD ST STE 206B
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1730
Mailing Address - Country:US
Mailing Address - Phone:703-916-1211
Mailing Address - Fax:703-916-1213
Practice Address - Street 1:4810 BEAUREGARD ST STE 206B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1730
Practice Address - Country:US
Practice Address - Phone:703-916-1211
Practice Address - Fax:703-916-1213
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045674261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010070684Medicaid
VA010070694Medicaid
VA37000057004471Medicare UPIN
VA491760F04471Medicare ID - Type Unspecified