Provider Demographics
NPI:1356396766
Name:RAGHUPATHY, CHETHANA J (MD)
Entity type:Individual
Prefix:
First Name:CHETHANA
Middle Name:J
Last Name:RAGHUPATHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7707 PARAGON RD
Mailing Address - Street 2:STE 101
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4041
Mailing Address - Country:US
Mailing Address - Phone:937-208-6920
Mailing Address - Fax:937-208-6948
Practice Address - Street 1:7707 PARAGON RD
Practice Address - Street 2:STE 101
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4041
Practice Address - Country:US
Practice Address - Phone:937-208-6920
Practice Address - Fax:937-208-6948
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35081199R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2345224Medicaid
OH4088172Medicare PIN
OH4088174Medicare PIN
OH2345224Medicaid
OH4088173Medicare PIN