Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | D0036846 | MD |
Y | 207R00000X | Internist | D0036846 | MD |
Y | 111NI0900X | Internist | D0036846 | MD |
N | 207RA0401X | Internist - Addiction Medicine | D0036846 | MD |
NPI | 1316957871 |
---|---|
Provider Name | Dr. Bernard Howard Ravitz |
First Address | Maryland Line, MD 21105-0180 |
Second Address | Baltimore, MD 21239-2945 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 21/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
067341200 | (05) | MD |
8666BH | BLUE CROSS BLUE SHIELD (01) | MD |
E42983 | (02) | MD |