Provider Demographics
NPI:1437551355
Name:RAGHUNANDAN PURUSHOTHAMAN, FNU (MD)
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:RAGHUNANDAN PURUSHOTHAMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAGHUNANDAN
Other - Middle Name:
Other - Last Name:PURUSHOTHAMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBBS
Mailing Address - Street 1:200 LOTHROP ST STE G100
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 LOTHROP ST STE G100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2536
Practice Address - Country:US
Practice Address - Phone:412-692-4882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD461562207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine