Provider Demographics
NPI:1588720023
Name:VODELA, RAVINDHAR (MD)
Entity type:Individual
Prefix:
First Name:RAVINDHAR
Middle Name:
Last Name:VODELA
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 1:3301 MERCY HEALTH BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-1105
Mailing Address - Country:US
Mailing Address - Phone:513-686-5950
Mailing Address - Fax:513-686-5620
Practice Address - Street 1:3301 MERCY HEALTH BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1105
Practice Address - Country:US
Practice Address - Phone:513-686-5950
Practice Address - Fax:513-686-5620
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124797207RI0200X
OH35.123439207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036124797Medicaid
IL347713006Medicare PIN
OHH369640Medicare UPIN