Provider Demographics
NPI:1457505448
Name:GOVINDA, RAGHAVENDRA (MB, BS)
Entity Type:Individual
Prefix:DR
First Name:RAGHAVENDRA
Middle Name:
Last Name:GOVINDA
Suffix:
Gender:M
Credentials:MB, BS
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Mailing Address - Street 1:800 WASHINGTON ST # 298
Mailing Address - Street 2:DEPT OF ANESTHESIA, TUFTS MEDICAL CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1552
Mailing Address - Country:US
Mailing Address - Phone:617-636-9329
Mailing Address - Fax:617-636-8384
Practice Address - Street 1:800 WASHINGTON ST # 298
Practice Address - Street 2:DEPT OF ANESTHESIA, TUFTS MEDICAL CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-9329
Practice Address - Fax:617-636-8384
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA236972207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology