Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 2009014351 | MO |
N | 207T00000X | Neurosurgeon | MD461269 | PA |
N | 207T00000X | Neurosurgeon | MD60646514 | WA |
Y | 207T00000X | Neurosurgeon | ME140331 | FL |
NPI | 1003047150 |
---|---|
Provider Name | Dr. Raghuram Sampath |
First Address | Danville, PA 17822-4903 |
Second Address | Hialeah, FL 33016-1813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 05/09/2019 |