Individual
DR. REVATHI RAVI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(972) 679-2214
Mailing address
55 FRUIT ST, BOSTON, MA 02114-2621
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
123112
OH
207R00000X
Internal Medicine Physician
266645
MA
208000000X
Pediatrics Physician
266645
MA
208D00000X
General Practice Physician
Primary
266645
MA
Other
Enumeration date
05/07/2012
Last updated
05/02/2019
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