Provider Demographics
NPI:1598719940
Name:GOLI, RAJA SEKHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJA
Middle Name:SEKHAR
Last Name:GOLI
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:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-0432
Mailing Address - Country:US
Mailing Address - Phone:606-430-2209
Mailing Address - Fax:606-432-5422
Practice Address - Street 1:911 BYPASS RD BLDG A
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1602
Practice Address - Country:US
Practice Address - Phone:606-430-2209
Practice Address - Fax:606-218-7509
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36241207W00000X
TN60521207W00000X
MO2021004418207W00000X
IL036.156192207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ055952Medicaid
MO2021004418OtherLICENSE
FG2134120OtherDEA