Provider Demographics
NPI:1770582520
Name:RAMANATHAN, RAVI S (MD)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:S
Last Name:RAMANATHAN
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 1:291 N PECOS RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1918
Mailing Address - Country:US
Mailing Address - Phone:702-616-9471
Mailing Address - Fax:702-616-9681
Practice Address - Street 1:291 N PECOS RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1918
Practice Address - Country:US
Practice Address - Phone:702-616-9471
Practice Address - Fax:702-616-9681
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2018677Medicaid
CC0498OtherBC/BS
H24590Medicare UPIN
NV2018677Medicaid