Provider Demographics
NPI:1194955286
Name:RAGHAVAN, VIDYA (MD)
Entity type:Individual
Prefix:
First Name:VIDYA
Middle Name:
Last Name:RAGHAVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIDYA
Other - Middle Name:
Other - Last Name:RAGHAVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5855 BREMO RD
Mailing Address - Street 2:SUITE 408
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1930
Mailing Address - Country:US
Mailing Address - Phone:804-288-2673
Mailing Address - Fax:804-285-5572
Practice Address - Street 1:5855 BREMO RD
Practice Address - Street 2:SUITE 408
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1930
Practice Address - Country:US
Practice Address - Phone:804-288-2673
Practice Address - Fax:804-285-5572
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60901847207R00000X
MA240418207R00000X
VA0101253367207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN