Provider Demographics
NPI:1427210426
Name:MOHINDRA, RAGHAV (MD)
Entity Type:Individual
Prefix:
First Name:RAGHAV
Middle Name:
Last Name:MOHINDRA
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 1:8700 E UNIVERSITY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CROSSROADS
Mailing Address - State:TX
Mailing Address - Zip Code:76227
Mailing Address - Country:US
Mailing Address - Phone:940-290-0200
Mailing Address - Fax:940-448-7533
Practice Address - Street 1:8700 E UNIVERSITY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CROSSROADS
Practice Address - State:TX
Practice Address - Zip Code:76227
Practice Address - Country:US
Practice Address - Phone:940-945-6265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1779207RG0300X
AZ41238207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ130499Medicare PIN