Individual
DR. RAVI VARMA DATLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2101 E JEFFERSON ST, SUITE 308, ROCKVILLE, MD 20852-4908
(301) 816-7405
Mailing address
2101 E JEFFERSON ST, SUITE 308, ROCKVILLE, MD 20852-4908
(301) 816-7405
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101243191
VA
390200000X
Student in an Organized Health Care Education/Training Program
MT186124
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053596270
—
VA
01
—
302011
ANTHEM
VA
01
—
4195775
CIGNA
—
01
—
P00729695
RAILROAD MEDICARE
VA
Enumeration date
01/07/2008
Last updated
06/07/2021
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