Provider Demographics
NPI:1235117755
Name:RAGHUNATH, NAGAVEDU DEENADAYALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NAGAVEDU
Middle Name:DEENADAYALAN
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 1:1324 W ST NW
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-3508
Mailing Address - Country:US
Mailing Address - Phone:253-804-8300
Mailing Address - Fax:253-474-1871
Practice Address - Street 1:202 N DIVISION ST
Practice Address - Street 2:PLAZA ONE
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-4939
Practice Address - Country:US
Practice Address - Phone:253-334-6248
Practice Address - Fax:253-435-4555
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00000285912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1074863Medicaid
WAG8862039Medicare PIN
E59170Medicare UPIN