Provider Demographics
NPI:1639267727
Name:RAGUPATHI, KUPPUSAMY (MD)
Entity Type:Individual
Prefix:DR
First Name:KUPPUSAMY
Middle Name:
Last Name:RAGUPATHI
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 1:1602 ROCK PRAIRIE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845
Mailing Address - Country:US
Mailing Address - Phone:979-693-6641
Mailing Address - Fax:979-693-7493
Practice Address - Street 1:1602 ROCK PRAIRIE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845
Practice Address - Country:US
Practice Address - Phone:979-693-6641
Practice Address - Fax:979-693-7493
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2165207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032780101Medicaid
B19863Medicare UPIN
TX032780101Medicaid