Provider Demographics
NPI:1295708691
Name:RAVI, NATARAJAN (MD)
Entity type:Individual
Prefix:DR
First Name:NATARAJAN
Middle Name:
Last Name:RAVI
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 1:148 BRANDON TER
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-6003
Mailing Address - Country:US
Mailing Address - Phone:518-456-5202
Mailing Address - Fax:
Practice Address - Street 1:47,NEW SCOTLAND AVE,MC,47,
Practice Address - Street 2:ALBANY MEDICAL COLLEGE FACULTY PRACTICE
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3479
Practice Address - Country:US
Practice Address - Phone:518-262-1333
Practice Address - Fax:518-262-6996
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200271207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01576223Medicaid
NYRA9875Medicare ID - Type Unspecified
NY01576223Medicaid