Provider Demographics
NPI:1962401331
Name:RAVAL, NIRAV Y (MD)
Entity type:Individual
Prefix:
First Name:NIRAV
Middle Name:Y
Last Name:RAVAL
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 1:2995 DREW ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-315-7496
Mailing Address - Fax:
Practice Address - Street 1:2415 N ORANGE AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5505
Practice Address - Country:US
Practice Address - Phone:407-303-2172
Practice Address - Fax:407-303-0678
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054496207RC0000X
FLME 116401207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA346673887EFGIJKLMedicaid
GA5111060046Medicare PIN
GAI04244Medicare UPIN