Provider Demographics
NPI:1194749663
Name:RATAKONDA, RAVINDRA (MD)
Entity type:Individual
Prefix:
First Name:RAVINDRA
Middle Name:
Last Name:RATAKONDA
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 1:6943 ORCHID LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-4209
Mailing Address - Country:US
Mailing Address - Phone:214-987-2548
Mailing Address - Fax:
Practice Address - Street 1:4500 SOUTH LANCASTER ROAD
Practice Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS , NTHCS
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216
Practice Address - Country:US
Practice Address - Phone:214-742-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine