Provider Demographics
NPI:1306166277
Name:KAVASERY, RAVI (MD)
Entity type:Individual
Prefix:DR
First Name:RAVI
Middle Name:
Last Name:KAVASERY
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 1:101 TREMONT ST FL 6
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-5004
Mailing Address - Country:US
Mailing Address - Phone:617-804-5981
Mailing Address - Fax:617-701-7740
Practice Address - Street 1:912 RIVER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3715
Practice Address - Country:US
Practice Address - Phone:617-453-2303
Practice Address - Fax:617-329-4726
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA244879207R00000X
MA252445207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine