Provider Demographics
NPI:1043252455
Name:AMARAVADI, RAVI K (MD)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:K
Last Name:AMARAVADI
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 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:3RD FL WEST PAVILION
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5130
Mailing Address - Country:US
Mailing Address - Phone:215-615-5858
Mailing Address - Fax:215-615-3349
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:3RD FL WEST PAVILION
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5130
Practice Address - Country:US
Practice Address - Phone:215-615-5858
Practice Address - Fax:215-615-3349
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422849207R00000X, 207RX0202X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine