Provider Demographics
NPI:1366772220
Name:RAVIDA, ANTONIO SERRA (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:SERRA
Last Name:RAVIDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1120 SAINT PAUL ST
Mailing Address - Street 2:GROUND LEVEL
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2618
Mailing Address - Country:US
Mailing Address - Phone:410-685-7790
Mailing Address - Fax:410-685-5360
Practice Address - Street 1:1120 SAINT PAUL ST
Practice Address - Street 2:GROUND LEVEL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2618
Practice Address - Country:US
Practice Address - Phone:410-685-7790
Practice Address - Fax:410-685-5360
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDDO028572208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation