Provider Demographics
NPI:1396731402
Name:PACHIGOLLA, RAVI V (MD)
Entity type:Individual
Prefix:DR
First Name:RAVI
Middle Name:V
Last Name:PACHIGOLLA
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 1:2016 FORT WORTH HWY
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-4706
Mailing Address - Country:US
Mailing Address - Phone:817-596-8637
Mailing Address - Fax:855-217-1123
Practice Address - Street 1:2016 FORT WORTH HWY
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-4706
Practice Address - Country:US
Practice Address - Phone:817-596-8637
Practice Address - Fax:855-217-1123
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4763207YX0602X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z738OtherMEDICARE GROUP PIN
TX198437901OtherMEDICAID GROUP
TX198438701Medicaid
TXK4763OtherTX LICENSE
TX198438701Medicaid
TX00Z738OtherMEDICARE GROUP PIN