Provider Demographics
NPI:1255398244
Name:UBRIANI, RAVI R (MD)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:R
Last Name:UBRIANI
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 1:20200 54TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6389
Mailing Address - Country:US
Mailing Address - Phone:425-672-6400
Mailing Address - Fax:425-672-6484
Practice Address - Street 1:20200 54TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6389
Practice Address - Country:US
Practice Address - Phone:425-672-6400
Practice Address - Fax:425-672-6484
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN55008207N00000X
WAMD60713547207N00000X
MDD0068352207N00000X
FLME 109234207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02898346Medicaid
NY49C25EU721Medicare PIN