Provider Demographics
NPI:1134157019
Name:SRIVASTAVA, RAVI (MD)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:
Last Name:SRIVASTAVA
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 1:400 SENTARA CIR STE 320
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5716
Mailing Address - Country:US
Mailing Address - Phone:757-345-4800
Mailing Address - Fax:757-345-4801
Practice Address - Street 1:400 SENTARA CIR STE 320
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5716
Practice Address - Country:US
Practice Address - Phone:757-345-4800
Practice Address - Fax:757-345-4801
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.24120207R00000X
FLME103543207RC0000X
KY38693207RC0000X
VA0101263232207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001030400Medicaid
IN200487400AMedicaid
KY2446165000OtherPASSPORT ADVANTAGE PIN
KY000000330954OtherANTHEM PIN
IN200487400FMedicaid
KY50004815OtherPASSPORT PIN
KY64087554Medicaid
IN200487400FMedicaid
FLBU215ZMedicare PIN
KY2446165000OtherPASSPORT ADVANTAGE PIN
FL001030400Medicaid
IN200487400AMedicaid