Provider Demographics
NPI:1558631390
Name:RAGHAVAKURUP, LEKSHMINARAYAN (MD)
Entity Type:Individual
Prefix:
First Name:LEKSHMINARAYAN
Middle Name:
Last Name:RAGHAVAKURUP
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 1:2000 TALL TREES DR
Mailing Address - Street 2:504 TALL TREES APT
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-2204
Mailing Address - Country:US
Mailing Address - Phone:570-468-4865
Mailing Address - Fax:
Practice Address - Street 1:2000 TALL TREES DR
Practice Address - Street 2:504 TALL TREES APT
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2204
Practice Address - Country:US
Practice Address - Phone:570-468-4865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT 198537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine