Individual
JEREMY RAVUSSIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
611 WATKINS CENTRE PKWY, SUITE 250, MIDLOTHIAN, VA 23114-4404
(804) 423-8470
(804) 423-8471
Mailing address
611 WATKINS CENTRE PKWY, SUITE 250, MIDLOTHIAN, VA 23114-4404
(804) 423-8470
(804) 423-8471
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101257793
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C09633
GROUP PTAN
VA
Enumeration date
03/20/2012
Last updated
01/15/2016
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