Provider Demographics
NPI:1427044023
Name:OGIRALA, RAJA G (MD)
Entity Type:Individual
Prefix:
First Name:RAJA
Middle Name:G
Last Name:OGIRALA
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 1:3563 BAINBRIDGE AVE
Mailing Address - Street 2:#1L
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1407
Mailing Address - Country:US
Mailing Address - Phone:718-652-3000
Mailing Address - Fax:718-653-5762
Practice Address - Street 1:3044 29TH ST
Practice Address - Street 2:SUITE 1J
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2533
Practice Address - Country:US
Practice Address - Phone:718-652-3000
Practice Address - Fax:718-653-5762
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169251174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP408708OtherOXFORD
NY2C0054OtherHEALTHNET
NY02443OtherMEDICARE - GHI
NY39420POtherHIP
NYA61832Medicare UPIN
NY28E111Medicare ID - Type Unspecified