Provider Demographics
NPI:1649271750
Name:GREWAL, RAVNEET (MD)
Entity type:Individual
Prefix:DR
First Name:RAVNEET
Middle Name:
Last Name:GREWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19415 DEERFIELD AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8452
Mailing Address - Country:US
Mailing Address - Phone:703-729-6030
Mailing Address - Fax:703-729-1446
Practice Address - Street 1:19415 DEERFIELD AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8452
Practice Address - Country:US
Practice Address - Phone:703-729-6030
Practice Address - Fax:703-729-1446
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101220924174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2126931OtherMAMSI ONCOLOGY
VA8834468OtherCIGNA
VA3376538OtherAETNA PPO
VA7250194OtherAETNA HMO
VA3126931OtherMAMSI HEMATOLOGY
VA4126931OtherMAMSI INTERNAL MEDICINE
DCG01701Medicare PIN
VA3376538OtherAETNA PPO
VA4126931OtherMAMSI INTERNAL MEDICINE