Provider Demographics
NPI:1518949833
Name:VARAVENKATARAMAN, RAGHUPATHY (MD)
Entity Type:Individual
Prefix:
First Name:RAGHUPATHY
Middle Name:
Last Name:VARAVENKATARAMAN
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 1:1026 UNION RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224
Mailing Address - Country:US
Mailing Address - Phone:716-712-0851
Mailing Address - Fax:716-712-0853
Practice Address - Street 1:1026 UNION RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224
Practice Address - Country:US
Practice Address - Phone:716-712-0851
Practice Address - Fax:716-712-0853
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01300870Medicaid
NY0409755OtherIHA
NY00010182203OtherUNIVERA
NY401190OtherWELLCARE
NY000524993003OtherBC/BS
NY0409755OtherIHA
NY401190OtherWELLCARE
F26176Medicare UPIN