1235203803 NPI number — DR. RAGHAVENDRA NARAYANA SARALAYA M.D.

Table of content: DR. RAGHAVENDRA NARAYANA SARALAYA M.D. (NPI 1235203803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235203803 NPI number — DR. RAGHAVENDRA NARAYANA SARALAYA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SARALAYA
Provider First Name:
RAGHAVENDRA
Provider Middle Name:
NARAYANA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SARALAYA
Provider Other First Name:
RAJ
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.,P.A.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1235203803
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1215 S COULTER ST
Provider Second Line Business Mailing Address:
SUITE 403
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79106-1758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-677-2002
Provider Business Mailing Address Fax Number:
806-677-2004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 S COULTER ST
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-1758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-677-2002
Provider Business Practice Location Address Fax Number:
806-677-2004
Provider Enumeration Date:
11/17/2006

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:  K9897 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 146993401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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