Provider Demographics
NPI:1750885075
Name:KATRAGADDA, RATHNAVALI (MD)
Entity type:Individual
Prefix:DR
First Name:RATHNAVALI
Middle Name:
Last Name:KATRAGADDA
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:PO BOX 5291
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-5291
Mailing Address - Country:US
Mailing Address - Phone:432-221-4243
Mailing Address - Fax:432-221-5981
Practice Address - Street 1:400 ROSALIND REDFERN GROVER PKWY STE 271
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5857
Practice Address - Country:US
Practice Address - Phone:432-221-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU5729207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU5729OtherTX LICENSE