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Individual

RAGHAVA SHREE KAVALLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1505 W SHERMAN AVE, VINELAND, NJ 08360-7059
(856) 845-0100
Mailing address
PO BOX 191, ROCKLAND, DE 19732-0191

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
25MA10962500
NJ
2080N0001X
Neonatal-Perinatal Medicine Physician
272925
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
272925
MA
Enumeration date
06/13/2014
Last updated
07/21/2022
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