Provider Demographics
NPI:1306873922
Name:KADEVARI, RAVINDER R (MD)
Entity type:Individual
Prefix:DR
First Name:RAVINDER
Middle Name:R
Last Name:KADEVARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:ANGELS CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95222-0939
Mailing Address - Country:US
Mailing Address - Phone:209-754-6251
Mailing Address - Fax:209-754-6274
Practice Address - Street 1:5192 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-9524
Practice Address - Country:US
Practice Address - Phone:209-742-6144
Practice Address - Fax:209-754-6274
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA52443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG69276Medicare UPIN