Provider Demographics
NPI:1548217854
Name:NAGRAJ, HOSKOTE SUBBARAYA (MD)
Entity Type:Individual
Prefix:
First Name:HOSKOTE
Middle Name:SUBBARAYA
Last Name:NAGRAJ
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 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12652 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4392
Practice Address - Country:US
Practice Address - Phone:757-234-4285
Practice Address - Fax:757-234-4260
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027462207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE65291Medicare UPIN
VA1548217854Medicaid
VA019645R53Medicare PIN
VAP00736111Medicare PIN