Provider Demographics
NPI:1851391833
Name:KATRAGADDA, RAGHU RAM
Entity Type:Individual
Prefix:
First Name:RAGHU
Middle Name:RAM
Last Name:KATRAGADDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 MOWRY AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1730
Mailing Address - Country:US
Mailing Address - Phone:510-284-4100
Mailing Address - Fax:510-794-9783
Practice Address - Street 1:1860 MOWRY AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1730
Practice Address - Country:US
Practice Address - Phone:510-284-4100
Practice Address - Fax:510-794-9783
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78647207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH73411Medicare UPIN
CA00A786470Medicare ID - Type Unspecified