Provider Demographics
NPI:1063527588
Name:GADA, RAVI P (MD)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:P
Last Name:GADA
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 1:5477 GLEN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0946
Mailing Address - Country:US
Mailing Address - Phone:214-363-5965
Mailing Address - Fax:
Practice Address - Street 1:5477 GLEN LAKES DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0946
Practice Address - Country:US
Practice Address - Phone:214-363-5965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48617207V00000X
TXP2240207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN332633000Medicaid
MN332633000Medicaid
MN160002589Medicare ID - Type Unspecified