Healthcare Provider Details

I. General information

NPI: 1518198761
Provider Name (Legal Business Name): RAGHAVENDRA MULINTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 MACCORKLE AVE SE
CHARLESTON WV
25304-1210
US

IV. Provider business mailing address

3200 MACCORKLE AVE SE STE B16
CHARLESTON WV
25304-1227
US

V. Phone/Fax

Practice location:
  • Phone: 304-347-1315
  • Fax:
Mailing address:
  • Phone: 304-347-1315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25251
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number25251
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25251
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: