Basic Information
| Provider Information | |||||||||
| NPI: | 1861475915 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMRA | ||||||||
| FirstName: | RAVINDER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 N 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993015257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095477704 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7425 WRIGLEY DR | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993015292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095468400 | ||||||||
| FaxNumber: | 5095468391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD00046983 | WA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 160D410050 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 2002147 | 05 | WA | MEDICAID | 1602503942 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 160D410050 | 01 | MI | COMMUNITY BLUE | OTHER | C7620 | 01 | MI | MCARE | OTHER | 0982898 | 01 | MI | HEALTH PLUS | OTHER | 160D410050 | 01 | MI | BLUE CARE NETWORK | OTHER | 160D410050 | 01 | MI | BLUE CHOICE | OTHER | 4392820 | 05 | MI | MEDICAID | 5458749 | 01 | MI | AETNA | OTHER | G74988 | 01 | MI | HEALTH NET FEDERAL SERVIC | OTHER | 03775572 | 01 | MI | CIGNA | OTHER | 1002049 | 01 | MI | HEALTH ADVANTAGE NETWORK | OTHER | 3477128 | 05 | MI | MEDICAID | G74988 | 01 | MI | HAP | OTHER | 1002049 | 01 | MI | MCLAREN HEALTH PLAN | OTHER |