Provider Demographics
NPI:1972554541
Name:MAMEDI, RAVINDER (MD)
Entity type:Individual
Prefix:DR
First Name:RAVINDER
Middle Name:
Last Name:MAMEDI
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 1:321 HIGHWAY 125
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-6445
Mailing Address - Country:US
Mailing Address - Phone:252-537-8400
Mailing Address - Fax:252-537-9585
Practice Address - Street 1:321 HIGHWAY 125
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-6445
Practice Address - Country:US
Practice Address - Phone:252-537-8400
Practice Address - Fax:252-537-9585
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98-017042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89136MKMedicaid
NC2026282Medicare ID - Type UnspecifiedPROVIDER NUMBER
NC89136MKMedicaid