MEDICARE: DR. RAGHAVA RAJU 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	208200000X	Plastic Surgery Physician	129108	NY

General Provider Information

NPI Number	:	1588796312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAGHAVA RAJU MD

Provider Business Mailing Address
First Line	:	2131 RICHMOND ROAD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306
Country	:	US
Telephone Number	:	718-979-5553
Fax Number	:	718-979-5407

Provider Business Practice Location Address
First Line	:	2131 RICHMOND ROAD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306
Country	:	US
Telephone Number	:	718-979-5553
Fax Number	:	718-979-5407

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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