Healthcare Provider Details

I. General information

NPI: 1578501623
Provider Name (Legal Business Name): SHRAVAN RAJ SAXENA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 S PEARL ST
ALBANY NY
12202-1914
US

IV. Provider business mailing address

113 HOLLAND AVE VA MEDICAL CTR
ALBANY NY
12208
US

V. Phone/Fax

Practice location:
  • Phone: 518-449-0100
  • Fax: 518-463-8580
Mailing address:
  • Phone: 518-626-6620
  • Fax: 518-626-5916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number219991
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: