Provider Demographics
NPI:1619933843
Name:CHENNUPATI, RAJA SEKHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJA
Middle Name:SEKHAR
Last Name:CHENNUPATI
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 1:950 N 14TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1101
Mailing Address - Country:US
Mailing Address - Phone:409-833-5858
Mailing Address - Fax:409-833-1155
Practice Address - Street 1:950 N 14TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1112
Practice Address - Country:US
Practice Address - Phone:409-833-5858
Practice Address - Fax:409-833-1155
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9754207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX76-0233973OtherTAX ID
TX104524704Medicaid
TX8G0671OtherBCBS
TX104524704Medicaid
TX8A1460Medicare PIN