Provider Demographics
NPI:1538117924
Name:RAUNIKAR, ROBERT AUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:AUSTIN
Last Name:RAUNIKAR
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 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR
Practice Address - Street 2:SUITE A200
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3593
Practice Address - Country:US
Practice Address - Phone:864-454-5120
Practice Address - Fax:864-454-5106
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC174142080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG34931Medicaid
SC4334063OtherAETNA ID
SC4562972OtherCIGNA ID
SC576007863015OtherBCBS OF SC ID
SCG34931Medicaid
SC576007863015OtherBCBS OF SC ID
SC4562972OtherCIGNA ID
SC4334063OtherAETNA ID