Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 240418 | MA |
N | 111NI0900X | Internist | 240418 | MA |
Y | 207RH0002X | Hospice and Palliative Medicine | 0101253367 | VA |
NPI | 1194955286 |
---|---|
Provider Name | Vidya Raghavan |
First Address | Richmond, VA 23226-1930 |
Second Address | Richmond, VA 23226-1930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2009 |
Last Update Date | 05/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C06778 | GROUP PTAN (01) | VA |