Provider Demographics
NPI:1821033275
Name:RAYCHAUDHURI, SIBA PRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SIBA
Middle Name:PRASAD
Last Name:RAYCHAUDHURI
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 1:510 ASHTON AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-3607
Mailing Address - Country:US
Mailing Address - Phone:650-424-9147
Mailing Address - Fax:
Practice Address - Street 1:510 ASHTON AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-3607
Practice Address - Country:US
Practice Address - Phone:650-424-9147
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52869207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG71912Medicare UPIN