MEDICARE: DR. RAGHU SUDARSHAN ATHRE 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	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	M4701	TX
2	207YS0123X	Facial Plastic Surgery Physician	M4701	TX
3	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	M4701	TX

General Provider Information

NPI Number	:	1730265612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAGHU SUDARSHAN ATHRE MD

Provider Business Mailing Address
First Line	:	2414 ELLA BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-2710
Country	:	US
Telephone Number	:	281-557-3223
Fax Number	:	281-557-0164

Provider Business Practice Location Address
First Line	:	2414 ELLA BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-2710
Country	:	US
Telephone Number	:	281-557-3223
Fax Number	:	281-557-0164

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	04/10/2026

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