Provider Demographics
NPI:1992797146
Name:MANN, RAVINDER S (MD)
Entity type:Individual
Prefix:
First Name:RAVINDER
Middle Name:S
Last Name:MANN
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:DEPT 1044
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1044
Mailing Address - Country:US
Mailing Address - Phone:513-559-2723
Mailing Address - Fax:
Practice Address - Street 1:415 STRAIGHT ST
Practice Address - Street 2:STE 403
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1060
Practice Address - Country:US
Practice Address - Phone:513-559-2580
Practice Address - Fax:513-559-2596
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350689072084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200131820AMedicaid
KY64952294Medicaid
OH0184394Medicaid
OH4020256Medicare PIN
KY64952294Medicaid
G18811Medicare UPIN
KY0658202Medicare PIN