Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 35092083 | OH |
N | 207N00000X | Dermatologist | 41743 | AZ |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 35092083 | OH |
NPI | 1144230905 |
---|---|
Provider Name | Dr. Larisa Ravitskiy |
First Address | Gahanna, OH 43230-5342 |
Second Address | Gahanna, OH 43230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 07/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2901560 | (05) | OH |