Provider Demographics
NPI:1962436998
Name:KASTHURI, SARAVANAN (MD)
Entity type:Individual
Prefix:
First Name:SARAVANAN
Middle Name:
Last Name:KASTHURI
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 1:1341 SPAULDING AVENUE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-588-7613
Mailing Address - Fax:509-588-7611
Practice Address - Street 1:1341 SPAULDING AVENUE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-588-7613
Practice Address - Fax:509-588-7611
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000391022085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227335Medicaid
WA7038102Medicaid
WA8273492Medicaid
H35462Medicare UPIN
OR227335Medicaid
WAP00022256Medicare PIN