Provider Demographics
NPI:1174591515
Name:RAVITZ, GERALD ALAN (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:ALAN
Last Name:RAVITZ
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 1:100 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3519
Mailing Address - Country:US
Mailing Address - Phone:570-622-8903
Mailing Address - Fax:570-622-8037
Practice Address - Street 1:100 E UNION ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3519
Practice Address - Country:US
Practice Address - Phone:570-622-8903
Practice Address - Fax:570-622-8037
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015113E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000641347Medicaid
PA000641347Medicaid
PA105201DX7Medicare ID - Type Unspecified