Provider Demographics
NPI:1083669501
Name:PATHAPATI, RAJA S (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJA
Middle Name:S
Last Name:PATHAPATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3749 CHAMPIONS DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707
Mailing Address - Country:US
Mailing Address - Phone:409-981-8586
Mailing Address - Fax:409-981-8583
Practice Address - Street 1:3420 VETERANS CIR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707
Practice Address - Country:US
Practice Address - Phone:409-981-8550
Practice Address - Fax:409-981-8563
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA340829207R00000X, 208M00000X
FLME71265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME71265OtherLICENSE
TXM6335OtherSTATE LICENSE
TXM6335OtherSTATE LICENSE