Provider Demographics
NPI:1528164290
Name:RAGHUPATHY, KADE N (MD)
Entity type:Individual
Prefix:
First Name:KADE
Middle Name:N
Last Name:RAGHUPATHY
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:PO BOX 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:440-964-8387
Mailing Address - Fax:440-964-2742
Practice Address - Street 1:1527 W 19TH ST
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3033
Practice Address - Country:US
Practice Address - Phone:440-964-8387
Practice Address - Fax:440-964-2742
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35100207R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0280520Medicaid
F77156Medicare UPIN