Individual
PAVAN MAHENDRA RAVELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
170 MEDICAL PARK RD STE 101, MOORESVILLE, NC 28117-8541
(980) 302-7070
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(980) 302-7070
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
01075948A
IN
207RH0000X
Hematology (Internal Medicine) Physician
Primary
2025-03697
NC
207RX0202X
Medical Oncology Physician
01075948A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000964118
ANTHEM PROVIDER NUMBER
IN
05
—
201320510
—
IN
Enumeration date
10/02/2009
Last updated
12/30/2025
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