Provider Demographics
NPI:1992158737
Name:RAVICHANDRAN, SARANYA (MD)
Entity type:Individual
Prefix:DR
First Name:SARANYA
Middle Name:
Last Name:RAVICHANDRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S FAIRFIELD AVE
Mailing Address - Street 2:F444,
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1782
Mailing Address - Country:US
Mailing Address - Phone:773-257-6184
Mailing Address - Fax:
Practice Address - Street 1:105 FISCHER MARKETPLACE LN STE 200
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-3680
Practice Address - Country:US
Practice Address - Phone:770-502-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.069238208000000X
GA98408208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics