1518949833 NPI number — RAGHUPATHY VARAVENKATARAMAN MD

Table of content: RAGHUPATHY VARAVENKATARAMAN MD (NPI 1518949833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518949833 NPI number — RAGHUPATHY VARAVENKATARAMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARAVENKATARAMAN
Provider First Name:
RAGHUPATHY
Provider Middle Name:
Provider Name Prefix Text:
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:
1518949833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1026 UNION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST SENECA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-712-0851
Provider Business Mailing Address Fax Number:
716-712-0853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1026 UNION RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST SENECA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-712-0851
Provider Business Practice Location Address Fax Number:
716-712-0853
Provider Enumeration Date:
11/14/2005

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:  180886 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01300870 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0409755 . This is a "IHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010182203 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 401190 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000524993003 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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