Provider Demographics
NPI:1336289065
Name:POLAVARAM, RAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJ
Middle Name:
Last Name:POLAVARAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2025 GIOVANNI CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7106
Mailing Address - Country:US
Mailing Address - Phone:919-319-6610
Mailing Address - Fax:919-319-6365
Practice Address - Street 1:907 KILDAIRE FARM RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3922
Practice Address - Country:US
Practice Address - Phone:919-319-6610
Practice Address - Fax:919-319-6365
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801744207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH22020Medicare UPIN
2263425BMedicare PIN