Provider Demographics
NPI:1902896194
Name:JAHAGIRDAR, RAVINDRA R (MD)
Entity Type:Individual
Prefix:
First Name:RAVINDRA
Middle Name:R
Last Name:JAHAGIRDAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3101
Mailing Address - Country:US
Mailing Address - Phone:407-330-1100
Mailing Address - Fax:407-321-8820
Practice Address - Street 1:101 N 8TH ST
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3101
Practice Address - Country:US
Practice Address - Phone:407-330-1100
Practice Address - Fax:407-321-8820
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME044265208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59942Medicare ID - Type Unspecified
FLD57079Medicare UPIN