Provider Demographics
NPI:1629056460
Name:RAGURAM, PARTHASSARATHY CHETLUR (MD,MRCPI,FASN)
Entity Type:Individual
Prefix:
First Name:PARTHASSARATHY
Middle Name:CHETLUR
Last Name:RAGURAM
Suffix:
Gender:M
Credentials:MD,MRCPI,FASN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MEMORIAL MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4450
Mailing Address - Country:US
Mailing Address - Phone:864-220-1200
Mailing Address - Fax:864-220-1888
Practice Address - Street 1:10 MEMORIAL MEDICAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4450
Practice Address - Country:US
Practice Address - Phone:864-220-1200
Practice Address - Fax:864-220-1888
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22973207RN0300X
SC35551207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287621Medicaid
WA8288912Medicaid
SC355519Medicaid
SC355519Medicaid
OR287621Medicaid
ORR109703Medicare PIN