Basic Information
| Provider Information | |||||||||
| NPI: | 1962401331 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAVAL | ||||||||
| FirstName: | NIRAV | ||||||||
| MiddleName: | Y. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2415 N ORANGE AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328045505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073032172 | ||||||||
| FaxNumber: | 4073030678 | ||||||||
| Practice Location | |||||||||
| Address1: | 2415 N ORANGE AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328045505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073032172 | ||||||||
| FaxNumber: | 4073030678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 09/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 054496 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | ME 116401 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 346673887EFGIJKL | 05 | GA | MEDICAID |