Provider Demographics
NPI:1679884613
Name:RAGHAVA RAO POLAVARAPU,MDPC
Entity Type:Organization
Organization Name:RAGHAVA RAO POLAVARAPU,MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGHAVA
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:POLAVARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-230-0133
Mailing Address - Street 1:55 GREENE AVE STE 2C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6432
Mailing Address - Country:US
Mailing Address - Phone:718-230-0133
Mailing Address - Fax:718-398-3104
Practice Address - Street 1:55 GREENE AVE STE 2C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6432
Practice Address - Country:US
Practice Address - Phone:718-230-0133
Practice Address - Fax:718-398-3104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty