Provider Demographics
NPI:1588877096
Name:MADAN, RAVI AMRIT (MD)
Entity type:Individual
Prefix:DR
First Name:RAVI
Middle Name:AMRIT
Last Name:MADAN
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 1:450 MASSACHUSETTS AVE NW
Mailing Address - Street 2:#608
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-6200
Mailing Address - Country:US
Mailing Address - Phone:973-722-4058
Mailing Address - Fax:
Practice Address - Street 1:450 MASSACHUSETTS AVE NW
Practice Address - Street 2:#608
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-6200
Practice Address - Country:US
Practice Address - Phone:973-722-4058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07845700207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology