Provider Demographics
NPI:1366715369
Name:BALAJI RAGHU INC
Entity type:Organization
Organization Name:BALAJI RAGHU INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BALAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-760-5727
Mailing Address - Street 1:1001 CENTURY OAK DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-6212
Mailing Address - Country:US
Mailing Address - Phone:540-760-5727
Mailing Address - Fax:
Practice Address - Street 1:1936 OPITZ BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3360
Practice Address - Country:US
Practice Address - Phone:703-494-1984
Practice Address - Fax:703-494-1985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty