Provider Demographics
NPI:1538261144
Name:NARAHARI, REVATI D (MD)
Entity type:Individual
Prefix:DR
First Name:REVATI
Middle Name:D
Last Name:NARAHARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:REVATI
Other - Middle Name:D
Other - Last Name:POTHAMSETTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1507 S HIAWASSEE RD
Mailing Address - Street 2:STE # 105
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5718
Mailing Address - Country:US
Mailing Address - Phone:407-445-9224
Mailing Address - Fax:407-445-6236
Practice Address - Street 1:1507 S HIAWASSEE RD
Practice Address - Street 2:STE # 105
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5718
Practice Address - Country:US
Practice Address - Phone:407-445-9224
Practice Address - Fax:407-445-6236
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83715208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263837100Medicaid