Individual
RAVI KUMAR TITHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3150 CLINCH STREET SUITE 204, WASHINGTON SQUARE CLINIC, RICHLANDS, VA 24641
(276) 964-6711
(276) 964-2240
Mailing address
3150 CLINCH STREET SUITE 204, WASHINGTON SQUARE CLINIC, RICHLANDS, VA 24641
(276) 964-6711
(276) 964-2240
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101235493
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010163800
FEDERAL BLACK LUNG
—
01
—
164419
BLUE CROSS BLUE SHIELD
VA
Enumeration date
09/27/2006
Last updated
10/23/2008
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