Provider Demographics
NPI:1467429191
Name:GOLLAPUDI, RAGHAVA R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAGHAVA
Middle Name:R
Last Name:GOLLAPUDI
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:3131 BERGER AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4233
Mailing Address - Country:US
Mailing Address - Phone:858-244-6865
Mailing Address - Fax:858-244-6892
Practice Address - Street 1:3131 BERGER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4233
Practice Address - Country:US
Practice Address - Phone:858-244-6865
Practice Address - Fax:858-244-6892
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73392207RC0000X, 207RI0011X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A733920Medicaid
CA00A733920Medicaid
CAWA73392AMedicare PIN