Provider Demographics
NPI:1740920578
Name:AMBATI, RAVALI SANTOSHI (MD)
Entity type:Individual
Prefix:
First Name:RAVALI
Middle Name:SANTOSHI
Last Name:AMBATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SW MARKET ST STE 1650
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5739
Mailing Address - Country:US
Mailing Address - Phone:503-466-1668
Mailing Address - Fax:
Practice Address - Street 1:15455 NW GREENBRIER PKWY STE 111
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7357
Practice Address - Country:US
Practice Address - Phone:503-531-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD226161208000000X
OH35.154017208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics