Provider Demographics
NPI:1891768461
Name:GHUGE, RAGHAVENDRA V (MD)
Entity Type:Individual
Prefix:DR
First Name:RAGHAVENDRA
Middle Name:V
Last Name:GHUGE
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:PO BOX 8270
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-8270
Mailing Address - Country:US
Mailing Address - Phone:903-787-7533
Mailing Address - Fax:903-787-8825
Practice Address - Street 1:3187 PALUXY DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8303
Practice Address - Country:US
Practice Address - Phone:903-787-7533
Practice Address - Fax:903-787-8825
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0769207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031565702Medicaid
G27606Medicare UPIN
TX031565702Medicaid
TXP00227290Medicare PIN