Active NPI
Mamandur Raghu, M.D.
- Anesthesiology Physician
- Brooklyn, NY
National Provider Identifier
1154358968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 153512
- Practice address
- 560 Bay Ridge Pkwy
Brooklyn, NY 11209-3310 - Phone
- (718) 748-7831
- NPI assigned
- Jun 27, 2006
- Last updated
- Oct 5, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 153512 | NY | Primary |
Addresses
Primary practice location
560 Bay Ridge Pkwy
Brooklyn, NY 11209-3310
Mailing address
PO Box 270
Massapequa Park, NY 11762-0270
Phone (631) 264-2035
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 153512 | NY | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1286236800000",
"number": "1154358968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 270",
"city": "MASSAPEQUA PARK",
"state": "NY",
"postal_code": "117620270",
"telephone_number": "631-264-2035",
"fax_number": "631-264-1418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "560 BAY RIDGE PKWY",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112093310",
"telephone_number": "718-748-7831"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAGHU",
"first_name": "MAMANDUR",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-27",
"last_updated": "2010-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NY",
"license": "153512",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.