Provider Demographics
NPI:1922290675
Name:JUVVADI, RAGHU (MD)
Entity Type:Individual
Prefix:DR
First Name:RAGHU
Middle Name:
Last Name:JUVVADI
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 1:14690 SPRING HILL DR
Mailing Address - Street 2:STE 101 ATTN:CREDENTIALING
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:5362 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4562
Practice Address - Country:US
Practice Address - Phone:352-398-4573
Practice Address - Fax:352-398-4591
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429484207R00000X
FLME101869207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001141000Medicaid
FL145FQOtherBCBS OF FL
FLP01046791OtherRAILROAD MEDICARE ATTACHED TO GRP# DR6927
FLP01046791OtherRAILROAD MEDICARE ATTACHED TO GRP# DR6927