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Contact Information

RAVINDRAKUMAR GANGADHARIAH, MD
4624 PROGRESS DRIVE STE D
DAVENPORT, IA52807
 Phone: 563-355-0015
 Fax: 563-355-0013
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
 

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for RAVINDRAKUMAR GANGADHARIAH · (Male)

NPI Number 1922047869
Status Active
Credentials MD
Entity Individual
Enumeration date 06/06/2006
Last updated 04/04/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • IA License # 36638
  • IL License # 036-115671
  • IL License # 036115671
  • IA Medicaid 0744987
  • IL Medicaid 036115671
Hospital affiliation(s)
  • TRINITY BETTENDORF - (Acute Care)
    4500 UTICA RIDGE ROAD
    BETTENDORF, IA 52722
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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