MEDICARE: RAGHU ATHRE, MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	M4701	TX
2	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	M4701	TX
3	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	M4701	TX
4	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	058678	GA
5	207YS0123X	Facial Plastic Surgery Physician	M4701	TX

General Provider Information

NPI Number	:	1992983878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAGHU ATHRE, MD PA

Provider Business Mailing Address
First Line	:	1015 MEDICAL CENTER BLVD
Second Line	:	#1500
City	:	WEBSTER
State	:	TX
Zip	:	77598-4052
Country	:	US
Telephone Number	:	281-557-3223
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 MEDICAL CENTER BLVD
Second Line	:	SUITE 1500
City	:	WEBSTER
State	:	TX
Zip	:	77598-4052
Country	:	US
Telephone Number	:	281-557-3223
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAGHU SUDARSHAN ATHRE
Credential	:	MD
Telephone Number	:	281-557-3223

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	10/10/2008

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