Basic Information
| Provider Information | |||||||||
| NPI: | 1528388121 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANAGAMA | ||||||||
| FirstName: | RAVALI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 ACADEMY ST S | ||||||||
| Address2: | |||||||||
| City: | AHOSKIE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279103248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522093000 | ||||||||
| FaxNumber: | 2522093497 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 ACADEMY ST S | ||||||||
| Address2: | |||||||||
| City: | AHOSKIE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279103248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522093000 | ||||||||
| FaxNumber: | 2522093497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2013-01151 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.