Provider Demographics
NPI:1457347429
Name:NATHAN, RAGHU P (MD)
Entity Type:Individual
Prefix:DR
First Name:RAGHU
Middle Name:P
Last Name:NATHAN
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 1:2400 HOSPITAL DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2385
Mailing Address - Country:US
Mailing Address - Phone:318-747-2277
Mailing Address - Fax:318-747-2217
Practice Address - Street 1:2400 HOSPITAL DR
Practice Address - Street 2:SUITE 340
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2385
Practice Address - Country:US
Practice Address - Phone:318-747-2277
Practice Address - Fax:318-747-2217
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11049R207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1654191Medicaid
E92240Medicare UPIN
LA1654191Medicaid