Provider Demographics
NPI:1457352577
Name:MACHRA, RAVINDER K (MD)
Entity type:Individual
Prefix:DR
First Name:RAVINDER
Middle Name:K
Last Name:MACHRA
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 1:1067 VENDALL RD STE A
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1622
Mailing Address - Country:US
Mailing Address - Phone:731-285-9938
Mailing Address - Fax:731-287-8809
Practice Address - Street 1:1067 VENDALL RD STE A
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024
Practice Address - Country:US
Practice Address - Phone:731-288-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD38904207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
62-1815075OtherOMNI
TN4115392OtherBCBS
000000160231OtherBETTER HEALTH
TN3339815Medicaid
TN3725948Medicaid
4093047OtherBCBS
TN3725948Medicare PIN
TN3339815Medicare PIN
I20094Medicare UPIN