Healthcare Provider Details

I. General information

NPI: 1396708822
Provider Name (Legal Business Name): RAGHUVIR BAXIRAM GELOT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 NC HIGHWAY 42 W
AHOSKIE NC
27910-9743
US

IV. Provider business mailing address

202 NC HIGHWAY 42 W
AHOSKIE NC
27910-9743
US

V. Phone/Fax

Practice location:
  • Phone: 252-332-5917
  • Fax: 252-332-7721
Mailing address:
  • Phone: 252-332-5917
  • Fax: 252-332-7721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number20796
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: