Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | N3258 | TX |
NPI | 1003057902 |
---|---|
Provider Name | Dr. Archana Vargheese Raghavan |
First Address | Dallas, TX 75265-0865 |
Second Address | Houston, TX 77042-2300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2009 |
Last Update Date | 07/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
205553501 | (05) | TX |
8CD177 | BLUE CROSS BLUE SHIELD (01) | TX |
P00778582 | MEDICARE RAILROAD (01) | TX |