Provider Demographics
NPI:1457395360
Name:CHANDRASEKHARA, RAVI (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:
Last Name:CHANDRASEKHARA
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 1:8144 WALNUT HILL LN STE 450
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0906
Mailing Address - Country:US
Mailing Address - Phone:469-513-2666
Mailing Address - Fax:469-513-2667
Practice Address - Street 1:1018 E WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4914
Practice Address - Country:US
Practice Address - Phone:469-513-2666
Practice Address - Fax:469-513-2667
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0770207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037016501Medicaid
TX85551XOtherBCBS
TX060062653OtherRAILROAD MEDICARE
TX85551XOtherBCBS
TX8029MOMedicare ID - Type Unspecified