Provider Demographics
NPI:1922354547
Name:GARA, RADHA KRISHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:RADHA
Middle Name:KRISHNA
Last Name:GARA
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 1:72 STOBE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2523
Mailing Address - Country:US
Mailing Address - Phone:718-419-4288
Mailing Address - Fax:718-351-4163
Practice Address - Street 1:72 STOBE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2523
Practice Address - Country:US
Practice Address - Phone:718-419-4288
Practice Address - Fax:718-351-4163
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237012-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice