Provider Demographics
NPI:1134429756
Name:PAHWANI, RAVI N (MD)
Entity type:Individual
Prefix:DR
First Name:RAVI
Middle Name:N
Last Name:PAHWANI
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:FNU
Other - Middle Name:
Other - Last Name:RAVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 745040
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-5040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1004
Practice Address - Country:US
Practice Address - Phone:336-832-4380
Practice Address - Fax:336-832-4382
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN58440208M00000X
WI60487208M00000X
ALMD.35377207Q00000X
NC2018-01414208M00000X
IN01074434A208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL193453Medicaid
AL102I082813Medicare PIN