Provider Demographics
NPI:1295700508
Name:KAHATAPITIYA, RAVINDRA C (DO)
Entity type:Individual
Prefix:DR
First Name:RAVINDRA
Middle Name:C
Last Name:KAHATAPITIYA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 KEMPSVILLE RD
Mailing Address - Street 2:STE 200A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3920
Mailing Address - Country:US
Mailing Address - Phone:757-261-5910
Mailing Address - Fax:757-466-0321
Practice Address - Street 1:850 KEMPSVILLE RD
Practice Address - Street 2:STE 200A
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3920
Practice Address - Country:US
Practice Address - Phone:757-261-5910
Practice Address - Fax:757-466-0321
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010040213Medicaid
VA010040213Medicaid
003452S33Medicare ID - Type Unspecified