Provider Demographics
NPI:1164478301
Name:MUPPIDI, RAGHUNANDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAGHUNANDAN
Middle Name:
Last Name:MUPPIDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 WESTMONT DR STE 320
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-4368
Mailing Address - Country:US
Mailing Address - Phone:713-899-0298
Mailing Address - Fax:806-705-8029
Practice Address - Street 1:1140 WESTMONT DR STE 320
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-4368
Practice Address - Country:US
Practice Address - Phone:713-899-0298
Practice Address - Fax:806-705-8029
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4546207R00000X
TXQ9205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX362469402Medicaid