Provider Demographics
NPI:1205804606
Name:TARAVELLA, RONNIE VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:VINCENT
Last Name:TARAVELLA
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:PO BOX 14207
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70898-4207
Mailing Address - Country:US
Mailing Address - Phone:225-767-4668
Mailing Address - Fax:225-765-3430
Practice Address - Street 1:7809 JEFFERSON HWY STE D2
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1200
Practice Address - Country:US
Practice Address - Phone:225-767-4668
Practice Address - Fax:225-360-3900
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.0162982083A0300X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1934755Medicaid
LAB89379Medicare UPIN
LA50850Medicare ID - Type Unspecified