Provider Demographics
NPI:1588691406
Name:RAVAGE, CHRISTOPHER KEVIN (MD)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:KEVIN
Last Name:RAVAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:945 STEVENS DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3508
Mailing Address - Country:US
Mailing Address - Phone:509-943-2781
Mailing Address - Fax:509-946-8590
Practice Address - Street 1:945 STEVENS DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3508
Practice Address - Country:US
Practice Address - Phone:509-943-2781
Practice Address - Fax:509-946-8590
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032069207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060050067OtherRAILROAD MEDICARE
WA1104561Medicaid
F87913Medicare UPIN
060050067OtherRAILROAD MEDICARE