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General NPI Number Information
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NPI Number | 1700088879
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Entity Type | Individual
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Provider Name | RAGHUVEER VALLABHANENI M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 11/07/2016
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Provider Practice Location Address
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Address Line | 3333 N CALVERT ST JOHNSTON PROFESSIONAL BUILDING, SUITE #325
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City | BALTIMORE
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State | MD
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Zip | 21218-2867
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Country | US
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Telephone | 410-554-2950
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Fax |
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Provider Business Mailing Address
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Address Line | 3333 N CALVERT ST JOHNSTON PROFESSIONAL BUILDING, SUITE #325
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City | BALTIMORE
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State | MD
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Zip | 21218-2867
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Country | US
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Telephone | 410-554-2950
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | D0082481
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | MD044638
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License Number State | DC
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