Provider Demographics
NPI:1780080416
Name:GOLLAPALLI, RAVIKUMARI (MD)
Entity type:Individual
Prefix:
First Name:RAVIKUMARI
Middle Name:
Last Name:GOLLAPALLI
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 1:3630 CORRIERE RD APT 207
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-7971
Mailing Address - Country:US
Mailing Address - Phone:614-441-6422
Mailing Address - Fax:
Practice Address - Street 1:500 PLAZA CT
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8262
Practice Address - Country:US
Practice Address - Phone:614-441-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.064405207R00000X
PAMD461378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty