Provider Demographics
NPI:1457350159
Name:METREVELI, RAMAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMAZ
Middle Name:
Last Name:METREVELI
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 1:1941 LIMESTONE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5408
Mailing Address - Country:US
Mailing Address - Phone:302-994-3128
Mailing Address - Fax:302-998-6991
Practice Address - Street 1:1941 LIMESTONE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5408
Practice Address - Country:US
Practice Address - Phone:302-994-3128
Practice Address - Fax:302-998-6991
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006581208600000X
PAMD432554208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE011524W05Medicare ID - Type Unspecified
DE1000025157Medicare ID - Type Unspecified
DEH83023Medicare UPIN