Provider Demographics
NPI:1427210426
Name:MOHINDRA, RAGHAV (MD)
Entity type:Individual
Prefix:
First Name:RAGHAV
Middle Name:
Last Name:MOHINDRA
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 1:7900 E FLORENTINE RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2218
Mailing Address - Country:US
Mailing Address - Phone:928-493-9937
Mailing Address - Fax:928-304-7770
Practice Address - Street 1:7900 E FLORENTINE RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2218
Practice Address - Country:US
Practice Address - Phone:928-493-9937
Practice Address - Fax:928-304-7770
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41238207R00000X, 207RG0300X
TXN1779207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ130499Medicare PIN