Individual
DR. RAVILLA L MAHIDHAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12728 19TH AVE SE STE 200, EVERETT, WA 98208-6526
(425) 225-2700
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
(866) 366-2983
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
D81014
MD
207RI0011X
Interventional Cardiology Physician
MD450900
PA
207RI0011X
Interventional Cardiology Physician
Primary
MD60287555
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213409800
—
MD
01
—
AT540010
BCBS
MD
01
—
G8910100
MEDICARE
WA
Enumeration date
04/20/2007
Last updated
07/07/2021
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