Active NPI
Revathy Raju, MD
- Anesthesiology Physician
- Louisville, KY
National Provider Identifier
1336259266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 25155
- Practice address
- 231 E Chestnut St
Kosair Childrens Hospital
Louisville, KY 40202-1821 - Phone
- (502) 451-9949
- Fax
- (502) 451-4553
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- 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 | 25155 | KY | Primary |
Addresses
Primary practice location
231 E Chestnut St
Kosair Childrens Hospital
Louisville, KY 40202-1821
Mailing address
Dept 5090 PO Box 740041
Louisville, KY 40201-7441
Phone (502) 451-9949
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64251556 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25155 | KY | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1336259266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "DEPT 5090 PO BOX 740041",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402017441",
"telephone_number": "502-451-9949",
"fax_number": "502-451-4553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "231 E CHESTNUT ST",
"address_2": "KOSAIR CHILDRENS HOSPITAL",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402021821",
"telephone_number": "502-451-9949",
"fax_number": "502-451-4553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAJU",
"first_name": "REVATHY",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "KY",
"license": "25155",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64251556",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.