Provider Demographics
NPI:1134216856
Name:RAWAL, RAMAGAVRI R (MD)
Entity type:Individual
Prefix:
First Name:RAMAGAVRI
Middle Name:R
Last Name:RAWAL
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 1:2575 N COURTENAY PKWY
Mailing Address - Street 2:BREVARD COUNTY HEALTH DEPARTMENT
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953
Mailing Address - Country:US
Mailing Address - Phone:321-454-7148
Mailing Address - Fax:321-639-5762
Practice Address - Street 1:2275 S BABCOCK ST
Practice Address - Street 2:BREVARD COUNTY HEALTH DEPARTMENT
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5305
Practice Address - Country:US
Practice Address - Phone:321-454-7148
Practice Address - Fax:321-690-3276
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46790208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035828200Medicaid
FL035828200Medicaid
E65757Medicare UPIN