1225114424 NPI number — RAVI M KAMRA MD

Table of content: RAVI M KAMRA MD (NPI 1225114424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225114424 NPI number — RAVI M KAMRA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAMRA
Provider First Name:
RAVI
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225114424
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325B KENNEDY MEMORIAL DR
Provider Second Line Business Mailing Address:
SUITE 9
Provider Business Mailing Address City Name:
WATERVILLE
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04901-4562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-465-2700
Provider Business Mailing Address Fax Number:
207-465-2300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325B KENNEDY MEMORIAL DR
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
WATERVILLE
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04901-4562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-465-2700
Provider Business Practice Location Address Fax Number:
207-465-2300
Provider Enumeration Date:
10/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  013454 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 249860099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017511 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1041426 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".