Provider Demographics
NPI:1801086657
Name:KUMAR, RAVI JONNALAGADDA (MBBS)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:JONNALAGADDA
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:RAVI
Other - Middle Name:KUMAR
Other - Last Name:JONNALAGADDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 MONTGOMERY AVE
Mailing Address - Street 2:# 213
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2662
Mailing Address - Country:US
Mailing Address - Phone:484-270-8756
Mailing Address - Fax:
Practice Address - Street 1:1 MONTGOMERY AVE
Practice Address - Street 2:# 213
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2662
Practice Address - Country:US
Practice Address - Phone:484-270-8756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2009-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA427889208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery