Individual
DR. RAGHURAM G MALLYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
915 OLD FERN HILL RD BLDG A, BLDG A SUITE 5, WEST CHESTER, PA 19380
(610) 696-2850
(610) 696-7159
Mailing address
207 N BROAD ST, 3RD FLR, PHILADELPHIA, PA 19107-1500
(610) 696-2850
(610) 696-7159
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD424622
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102140390
—
PA
Enumeration date
05/21/2007
Last updated
07/13/2023
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