Healthcare Provider Details

I. General information

NPI: 1295301265
Provider Name (Legal Business Name): RAGHAV TRIPATHI MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 08/23/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N CAROLINE ST
BALTIMORE MD
21287-0006
US

IV. Provider business mailing address

601 N CAROLINE ST
BALTIMORE MD
21287-0006
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5933
  • Fax:
Mailing address:
  • Phone: 410-955-5933
  • Fax: 443-683-8330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberAJ4147357
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR-12094
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: