Provider Demographics
NPI:1124147822
Name:RAGHUVEER ANNAM M.D.,P.C.
Entity type:Organization
Organization Name:RAGHUVEER ANNAM M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGHUVEER
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-859-5872
Mailing Address - Street 1:461 CORLISS AVE
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1501
Mailing Address - Country:US
Mailing Address - Phone:908-859-5872
Mailing Address - Fax:908-859-1747
Practice Address - Street 1:461 CORLISS AVE
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1501
Practice Address - Country:US
Practice Address - Phone:908-859-5872
Practice Address - Fax:908-859-1747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05360800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0471500Medicaid
NJ0471500Medicaid
NJ0471500Medicaid
NJAN585310Medicare ID - Type Unspecified