Provider Demographics
NPI:1487810305
Name:PULIPATI, RAVI CHANDRA (MD)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:CHANDRA
Last Name:PULIPATI
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 1:33 MEDFORD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1222
Mailing Address - Country:US
Mailing Address - Phone:631-569-5410
Mailing Address - Fax:631-569-5413
Practice Address - Street 1:33 MEDFORD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1222
Practice Address - Country:US
Practice Address - Phone:631-569-5410
Practice Address - Fax:631-569-5413
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2247282086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300000259Medicare PIN