Provider Demographics
NPI:1508421272
Name:RAGHUBIR, JAVITA (PA-C)
Entity Type:Individual
Prefix:
First Name:JAVITA
Middle Name:
Last Name:RAGHUBIR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8195 POOR HOUSE HL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IN
Mailing Address - Zip Code:47001-7536
Mailing Address - Country:US
Mailing Address - Phone:201-725-7261
Mailing Address - Fax:
Practice Address - Street 1:587 W EADS PKWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1157
Practice Address - Country:US
Practice Address - Phone:812-539-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1003436A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant