Provider Demographics
NPI:1174732861
Name:MAKWANA, RAVI TRIKAMLAL (MD)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:TRIKAMLAL
Last Name:MAKWANA
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 1:1723 NORTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3133
Mailing Address - Country:US
Mailing Address - Phone:610-253-7211
Mailing Address - Fax:610-258-8106
Practice Address - Street 1:1723 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3133
Practice Address - Country:US
Practice Address - Phone:610-253-7211
Practice Address - Fax:610-258-8106
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432043207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1975123OtherBLUE SHIELD
PA285655500OtherINDEPENDENCE BLUE CROSS
PA1975123OtherHIGHMARK BS
PA1019844190001Medicaid
PA50086960OtherCAPITAL BLUE CROSS
PA101984419 0004Medicaid
PA1975123OtherBLUE SHIELD