Provider Demographics
NPI:1043304249
Name:RAVIN, NEIL DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:DOUGLAS
Last Name:RAVIN
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 1:62 BROWN ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6778
Mailing Address - Country:US
Mailing Address - Phone:978-478-5030
Mailing Address - Fax:978-377-0412
Practice Address - Street 1:62 BROWN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6778
Practice Address - Country:US
Practice Address - Phone:978-478-5030
Practice Address - Fax:978-377-0412
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD26704174400000X
NH13807207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30207923Medicaid
ME432885799Medicaid
NH3082885Medicaid
NH000511001Medicare PIN
MDB94739Medicare UPIN