1922290675 NPI number — DR. RAGHU JUVVADI MD

Table of content: DR. RAGHU JUVVADI MD (NPI 1922290675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922290675 NPI number — DR. RAGHU JUVVADI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUVVADI
Provider First Name:
RAGHU
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922290675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14690 SPRING HILL DR
Provider Second Line Business Mailing Address:
STE 101 ATTN:CREDENTIALING
Provider Business Mailing Address City Name:
SPRING HILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34609-8102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-799-0046
Provider Business Mailing Address Fax Number:
352-606-2857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5362 SPRING HILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING HILL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34606-4562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-398-4573
Provider Business Practice Location Address Fax Number:
352-398-4591
Provider Enumeration Date:
08/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD429484 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: ME101869 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001141000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145FQ . This is a "BCBS OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P01046791 . This is a "RAILROAD MEDICARE ATTACHED TO GRP# DR6927" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com