Provider Demographics
NPI:1679542120
Name:RAVI, LINGAMURTHY (MD)
Entity type:Individual
Prefix:DR
First Name:LINGAMURTHY
Middle Name:
Last Name:RAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:845 S FAIRMONT AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5113
Practice Address - Country:US
Practice Address - Phone:209-339-7625
Practice Address - Fax:209-339-7419
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54849207R00000X, 207RC0200X, 207RP1001X, 207RS0012X, 208M00000X
TN37483207RP1001X
IN01066183A207RP1001X
KY41191207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6407843900Medicaid
IN000000696138OtherANTHEM PROVIDER NUMBER / TIN 35-2030653
IN200878960Medicaid
KY357400OtherANTHEM BCBS
KY000000518675OtherANTHEM (CHS INC - PPCC)
INP00911300Medicare PIN
KYP00406625Medicare PIN
IN000000696138OtherANTHEM PROVIDER NUMBER / TIN 35-2030653
IN200878960Medicaid
KY357400OtherANTHEM BCBS
IN249390DMedicare PIN