Provider Demographics
NPI:1679864508
Name:RAVERTY, MEGAN KATHLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:KATHLEEN
Last Name:RAVERTY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 297 DEPT OF PM&R
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-625-2661
Mailing Address - Fax:612-624-6686
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:MMC 297 DEPT OF PM&R
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-625-2661
Practice Address - Fax:612-624-6686
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2025-02-12
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Provider Licenses
StateLicense IDTaxonomies
MN59004208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation