Healthcare Provider Details

I. General information

NPI: 1174671275
Provider Name (Legal Business Name): GOWRI D SATHIRAJU MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 MALCOLM BLVD. SUITE F
RUTHERFORD COLLEGE NC
28671-0848
US

IV. Provider business mailing address

560 MALCOLM BLVD SUITE F
RUTHERFORD COLLEGE NC
28671
US

V. Phone/Fax

Practice location:
  • Phone: 828-879-3400
  • Fax: 828-879-3403
Mailing address:
  • Phone: 828-879-3400
  • Fax: 828-879-3403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200001429
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9901311
License Number StateNC

VIII. Authorized Official

Name: DR. GOWRI DEVI SATHIRAJU
Title or Position: DR
Credential: MD
Phone: 828-879-3400