Provider Demographics
NPI:1912972522
Name:ANANDAKRISHNAN, RAVI KRISHNAN (MD)
Entity type:Individual
Prefix:DR
First Name:RAVI
Middle Name:KRISHNAN
Last Name:ANANDAKRISHNAN
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:PO BOX 2595
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21041-2595
Mailing Address - Country:US
Mailing Address - Phone:443-858-4947
Mailing Address - Fax:
Practice Address - Street 1:821 N EUTAW ST
Practice Address - Street 2:SUITE 305
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4648
Practice Address - Country:US
Practice Address - Phone:410-669-9318
Practice Address - Fax:410-728-0656
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029071174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1508086521OtherNPI
MDB68131Medicare UPIN
MD1508086521OtherNPI