Shyam Sampath Raghavan, M.D.
Pathology, Dermatopathology in Charlottesville, VA. Individual provider (NPI-1).
NPI number1124394572
StatusActive
Last updated in NPPESAug 8, 2023
Details
- NPI
- 1124394572
- Entity type
- Individual (NPI-1)
- Name
- Shyam Sampath Raghavan
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 30, 2012
- Certification date
- Aug 8, 2023
- Last updated
- Aug 8, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207ZD0900X | Pathology, Dermatopathology | DR.0070540 | CO | Yes |
| 207ZD0900X | Pathology, Dermatopathology | 101269055 | VA | |
| 207ZP0102X | Pathology, Anatomic Pathology & Clinical Pathology | 101269055 | VA | |
| 208200000X | Plastic Surgery | A127813 | CA |
Practice location
1215 Lee StCharlottesville, VA 22908-2205
Phone 888-882-3990 · Fax 434-243-6499
Mailing address
Po Box 110429Aurora, CO 80042-0429
Other practice locations
12605 E 16th Ave
Aurora, CO 80045-2545
Aurora, CO 80045-2545
Phone 720-848-0000
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