Provider Demographics
NPI:1285802892
Name:TARIGOPULA, RAVALI (MD)
Entity type:Individual
Prefix:
First Name:RAVALI
Middle Name:
Last Name:TARIGOPULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0002
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:309 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7407
Practice Address - Country:US
Practice Address - Phone:318-966-4541
Practice Address - Fax:318-966-4543
Is Sole Proprietor?:No
Enumeration Date:2008-02-16
Last Update Date:2025-01-31
Deactivation Date:2019-01-21
Deactivation Code:
Reactivation Date:2019-01-23
Provider Licenses
StateLicense IDTaxonomies
LA310381207R00000X, 207RC0200X, 207RS0012X, 208M00000X, 207RP1001X
ALMD.34174207R00000X, 207RC0200X, 207RP1001X, 207RS0012X
MS30516207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2478508Medicaid
LA310381OtherSTATE LICENSE
MS200013744Medicaid