Provider Demographics
NPI:1912111055
Name:RAGHAVAN, SENTHIL K (MD, MPH)
Entity Type:Individual
Prefix:MR
First Name:SENTHIL
Middle Name:K
Last Name:RAGHAVAN
Suffix:
Gender:M
Credentials:MD, MPH
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 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-347-2023
Practice Address - Street 1:11219 FINANCIAL CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3800
Practice Address - Country:US
Practice Address - Phone:501-455-2712
Practice Address - Fax:501-569-3548
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5276207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR166954001Medicaid
AR5N996Medicare PIN
ARP00605534Medicare PIN
AR57297Medicare PIN