Provider Demographics
NPI:1225455207
Name:RAGHUNATH, RAJU (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJU
Middle Name:
Last Name:RAGHUNATH
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 1:230 O CONNOR RIDGE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6513
Mailing Address - Country:US
Mailing Address - Phone:214-666-6259
Mailing Address - Fax:817-725-7885
Practice Address - Street 1:230 O CONNOR RIDGE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6513
Practice Address - Country:US
Practice Address - Phone:214-666-6259
Practice Address - Fax:817-725-7885
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10048379207Q00000X
TXQ6461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX534545YSE6Medicare UPIN