Provider Demographics
NPI:1922050012
Name:RAGHU, BELLAMKONDA S (MD)
Entity Type:Individual
Prefix:
First Name:BELLAMKONDA
Middle Name:S
Last Name:RAGHU
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 1:4985 HARLEM ROAD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-839-0500
Mailing Address - Fax:716-839-0523
Practice Address - Street 1:4985 HARLEM ROAD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-839-0500
Practice Address - Fax:716-839-0523
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1941732084P0800X
NYMD1941732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01843232Medicaid
NYDD2024Medicare ID - Type Unspecified
G09202Medicare UPIN
NY01843232Medicaid