MEDICARE: SHRAVAN RAJ SAXENA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	219991	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000407996002	OTHER	NY	HEALTH NOW - BLUE SHIELD

General Provider Information

NPI Number	:	1578501623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHRAVAN RAJ SAXENA MD

Provider Business Mailing Address
First Line	:	113 HOLLAND AVE
Second Line	:	VA MEDICAL CTR
City	:	ALBANY
State	:	NY
Zip	:	12208
Country	:	US
Telephone Number	:	518-626-6620
Fax Number	:	518-626-5916

Provider Business Practice Location Address
First Line	:	326 S PEARL ST
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12202-1914
Country	:	US
Telephone Number	:	518-449-0100
Fax Number	:	518-463-8580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	06/17/2008

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