Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 25MA10848800 | NJ |
N | 207RA0201X | Internist - Allergy & Immunology | D73924 | MD |
NPI | 1629301817 |
---|---|
Provider Name | Juan Ravell |
First Address | Bethesda, MD 20814 |
Second Address | Hackensack, NJ 07601-8566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2009 |
Last Update Date | 16/06/2020 |