Provider Demographics
NPI:1154582377
Name:SIRAGAVARAPU, RAGHAVENDRA RAO (MD)
Entity type:Individual
Prefix:DR
First Name:RAGHAVENDRA
Middle Name:RAO
Last Name:SIRAGAVARAPU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1401 MARLTON PIKE E STE 27
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2207
Mailing Address - Country:US
Mailing Address - Phone:856-448-4989
Mailing Address - Fax:
Practice Address - Street 1:1401 MARLTON PIKE E STE 27
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2207
Practice Address - Country:US
Practice Address - Phone:856-872-7055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA119962002084P0804X
PAMD4384942084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry