Provider Demographics
NPI:1013953348
Name:RAVERT, STEVEN D (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:RAVERT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-2711
Mailing Address - Country:US
Mailing Address - Phone:570-286-8873
Mailing Address - Fax:570-286-8125
Practice Address - Street 1:212 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-2711
Practice Address - Country:US
Practice Address - Phone:570-286-8873
Practice Address - Fax:570-286-8125
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2014-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001722L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001638462Medicaid
PA0666660001OtherDME
PA001638462Medicaid
PA126004Medicare ID - Type Unspecified