Ravi C Maddali, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

045922 Issued in NY

Practice address

639 W 173Rd St
Suite # 1 a
New York, NY 10032-1425

Phone

(212) 928-4480

Fax

(212) 928-8389

NPI assigned

May 26, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ravi C Maddali, DDS, PC

  • General Practice Dentistry
  • New York, NY
  • NPI 1114178795
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1528014602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "639 W 173RD ST",
            "address_2": "SUITE # 1 A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321425",
            "telephone_number": "212-928-4480",
            "fax_number": "212-928-8389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "639 W 173RD ST",
            "address_2": "SUITE # 1 A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321425",
            "telephone_number": "212-928-4480",
            "fax_number": "212-928-8389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADDALI",
        "first_name": "RAVI",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "045922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01704829",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sanjana Madaram
• Saira Madarasmi
• Katalin Madaraz, SLP
• Alejandro Fabian Maddalena, L.M.H.C.
• Navya Maddali, PHARMD
• Vineeta Maddali
• Scott Lawrence Maddalo, M.D.
• Ann Madden, MA, CCC-SLP
• Eli Madden
• Kathleen Marie Madden, NP

• General Practice Dentistry in New York, NY
• Providers in New York, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.