Provider Demographics
NPI:1003047150
Name:SAMPATH, RAGHURAM (MD)
Entity Type:Individual
Prefix:DR
First Name:RAGHURAM
Middle Name:
Last Name:SAMPATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAGHU RAM
Other - Middle Name:
Other - Last Name:SAMPATH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:7100 W 20TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1813
Practice Address - Country:US
Practice Address - Phone:305-823-8510
Practice Address - Fax:305-823-8530
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME140331207T00000X
PAMD461269207T00000X
MO2009014351207T00000X
WAMD60646514207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery