Provider Demographics
NPI:1710137070
Name:ELUMALAI, JAGADISH VENKAT RAGA (MD)
Entity Type:Individual
Prefix:DR
First Name:JAGADISH VENKAT RAGA
Middle Name:
Last Name:ELUMALAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAGADISH
Other - Middle Name:
Other - Last Name:ELUMALAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8700 SUDLEY RD
Mailing Address - Street 2:MANASSAS NEONATAL ASSOCIATES
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4418
Mailing Address - Country:US
Mailing Address - Phone:703-369-8134
Mailing Address - Fax:
Practice Address - Street 1:8700 SUDLEY RD
Practice Address - Street 2:MANASSAS NEONATAL ASSOCIATES
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4418
Practice Address - Country:US
Practice Address - Phone:703-369-8134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012561552080N0001X
NYID 935460208000000X
IN01070556A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics