Provider Demographics
NPI:1922198753
Name:DOMMARAJU, SARATH B (MD)
Entity Type:Individual
Prefix:DR
First Name:SARATH
Middle Name:B
Last Name:DOMMARAJU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 ASHVILLE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6134
Mailing Address - Country:US
Mailing Address - Phone:919-858-0600
Mailing Address - Fax:919-858-0540
Practice Address - Street 1:400 ASHVILLE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6134
Practice Address - Country:US
Practice Address - Phone:919-858-0600
Practice Address - Fax:919-858-0540
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2011-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301088908208000000X
NC2007-00317208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics