Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD422849 | PA |
N | 111NI0900X | Internist | MD422849 | PA |
Y | 207RX0202X | Medical Oncology | MD422849 | PA |
NPI | 1043252455 |
---|---|
Provider Name | Ravi K Amaravadi |
First Address | Philadelphia, PA 19104-5130 |
Second Address | Philadelphia, PA 19104-5130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 21/08/2019 |