Provider Demographics
NPI:1962403196
Name:RAVAL, RAJU B (DO)
Entity type:Individual
Prefix:DR
First Name:RAJU
Middle Name:B
Last Name:RAVAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:RAJU
Other - Middle Name:B
Other - Last Name:RAVAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 87707
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-5956
Mailing Address - Country:US
Mailing Address - Phone:910-826-7828
Mailing Address - Fax:910-864-7925
Practice Address - Street 1:9525 CLIFFDALE ROAD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-5956
Practice Address - Country:US
Practice Address - Phone:910-826-7828
Practice Address - Fax:910-864-7925
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903128Medicaid
NC1110GOtherBCBS GROUP # 015CK
NC027AUOtherBCBS
NCG15059Medicare UPIN
NC2400356GMedicare PIN