Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO326 | DC |
Y | 222Z00000X | Podiatrist | PO326 | DC |
NPI | 1003870841 |
---|---|
Provider Name | Dr. Arnold S. Ravick |
First Address | Washington, DC 20036-3701 |
Second Address | Washington, DC 20036-3716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 01/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
480013906 | RR MEDICARE INDIVIDUAL PROVIDER # (01) | DC |
T30890 | (02) | DC |