Provider Demographics
NPI:1730265612
Name:ATHRE, RAGHU SUDARSHAN (MD)
Entity type:Individual
Prefix:DR
First Name:RAGHU
Middle Name:SUDARSHAN
Last Name:ATHRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 SAGE RD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-4390
Mailing Address - Country:US
Mailing Address - Phone:281-557-3223
Mailing Address - Fax:
Practice Address - Street 1:2121 SAGE RD
Practice Address - Street 2:SUITE 245
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-4390
Practice Address - Country:US
Practice Address - Phone:281-557-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058678207YX0905X
TXM4701207YS0123X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F8697Medicare PIN