Provider Demographics
NPI:1396848354
Name:RAGHAVAN, CHAKRAVARTHY (MD)
Entity Type:Individual
Prefix:
First Name:CHAKRAVARTHY
Middle Name:
Last Name:RAGHAVAN
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 1:2111 SW 20TH PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7734
Mailing Address - Country:US
Mailing Address - Phone:407-738-4200
Mailing Address - Fax:407-705-2540
Practice Address - Street 1:2111 SW 20TH PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7734
Practice Address - Country:US
Practice Address - Phone:407-738-4200
Practice Address - Fax:407-705-2540
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69260207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250067100Medicaid
FLME69260OtherLICENSE
FL100711000Medicaid