Provider Demographics
NPI:1447315619
Name:RAVAL, VIKRAM A (MD)
Entity type:Individual
Prefix:
First Name:VIKRAM
Middle Name:A
Last Name:RAVAL
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:PO BOX 3509
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44513-3509
Mailing Address - Country:US
Mailing Address - Phone:330-758-8353
Mailing Address - Fax:330-758-0369
Practice Address - Street 1:7250 WEST BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4346
Practice Address - Country:US
Practice Address - Phone:330-758-8353
Practice Address - Fax:330-758-0369
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350385952085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0420468Medicaid
WV0221815000Medicaid
P00221416Medicare ID - Type UnspecifiedUHC RR MEDICARE
OH0420468Medicaid
WV0221815000Medicaid
OHD97868Medicare UPIN