Individual
DR. VIJAY M RAGHAVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1460 BLUEGRASS AVE, LOUISVILLE, KY 40215-1272
(502) 361-8496
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 361-8496
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
01043397A
IN
207RX0202X
Medical Oncology Physician
Primary
33876
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64338767
—
KY
05
—
6590070600
—
KY
Enumeration date
08/09/2005
Last updated
10/13/2021
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