Healthcare Provider Details

I. General information

NPI: 1326141763
Provider Name (Legal Business Name): GOWRI DEVI SATHIRAJU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 MALCOLM BLVD. SUITE F1
RUTHERFORD COLLEGE NC
28671
US

IV. Provider business mailing address

PO BOX 848
RUTHERFORD COLLEGE NC
28671-0848
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200001429
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: