Provider Demographics
NPI:1821264862
Name:RAGHAVAN, ANITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITHA
Middle Name:
Last Name:RAGHAVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18511 MISSION VIEW DR STE 120
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-2975
Mailing Address - Country:US
Mailing Address - Phone:301-655-6088
Mailing Address - Fax:
Practice Address - Street 1:18511 MISSION VIEW DR STE 120
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-2975
Practice Address - Country:US
Practice Address - Phone:408-779-9422
Practice Address - Fax:408-779-4113
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60003292207R00000X
CAA121514207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8880764Medicare PIN
WAG8880552Medicare PIN