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Individual

SHYAM SAMPATH RAGHAVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1215 LEE ST, CHARLOTTESVILLE, VA 22908-2205
(888) 882-3990
(434) 243-6499
Mailing address
PO BOX 110429, AURORA, CO 80042-0429

Taxonomy

Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
101269055
VA
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
DR.0070540
CO
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
101269055
VA
208200000X
Plastic Surgery Physician
A127813
CA

Other

Enumeration date
03/30/2012
Last updated
08/08/2023
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