Provider Demographics
NPI:1770554321
Name:RAVI, NANDAKUMAR (MD)
Entity type:Individual
Prefix:
First Name:NANDAKUMAR
Middle Name:
Last Name:RAVI
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:PO BOX 22470
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-2470
Mailing Address - Country:US
Mailing Address - Phone:661-588-8725
Mailing Address - Fax:661-588-8749
Practice Address - Street 1:9870 BRIMHALL RD UNIT 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2798
Practice Address - Country:US
Practice Address - Phone:661-588-8725
Practice Address - Fax:661-588-8749
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64007207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A640070Medicaid
CA00A640070Medicaid
CA00A640071Medicare PIN
CA00A640073Medicare PIN