Provider Demographics
NPI:1174671275
Name:GOWRI D SATHIRAJU MD PA
Entity Type:Organization
Organization Name:GOWRI D SATHIRAJU MD PA
Other - Org Name:AS ABOVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:GOWRI
Authorized Official - Middle Name:DEVI
Authorized Official - Last Name:SATHIRAJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-879-3400
Mailing Address - Street 1:560 MALCOLM BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:RUTHERFORD COLLEGE
Mailing Address - State:NC
Mailing Address - Zip Code:28671
Mailing Address - Country:US
Mailing Address - Phone:828-879-3400
Mailing Address - Fax:828-879-3403
Practice Address - Street 1:560 MALCOLM BLVD.
Practice Address - Street 2:SUITE F
Practice Address - City:RUTHERFORD COLLEGE
Practice Address - State:NC
Practice Address - Zip Code:28671-0848
Practice Address - Country:US
Practice Address - Phone:828-879-3400
Practice Address - Fax:828-879-3403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001429207Q00000X
NC9901311207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC014WOtherBLUE CROSS BLUE SHIELD
NC2332147OtherMEDICARE PTAN
NC89014MWMedicaid
NC2332147OtherMEDICARE PTAN