Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 020800 | GA |
NPI | 1043258460 |
---|---|
Provider Name | Anthony A Raviele |
First Address | Atlanta, GA 30341 |
Second Address | Atlanta, GA 30342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00179506C | (05) | GA |
D30567 | (02) |