Provider Demographics
NPI:1629056460
Name:RAGURAM, PARTHASSARATHY CHETLUR (MD,MRCPI,FASN)
Entity type:Individual
Prefix:
First Name:PARTHASSARATHY
Middle Name:CHETLUR
Last Name:RAGURAM
Suffix:
Gender:M
Credentials:MD,MRCPI,FASN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N SUNRISE AVE STE 1202
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2932
Mailing Address - Country:US
Mailing Address - Phone:916-789-1505
Mailing Address - Fax:916-789-1513
Practice Address - Street 1:151 N SUNRISE AVE STE 1202
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2932
Practice Address - Country:US
Practice Address - Phone:916-789-1505
Practice Address - Fax:916-789-1513
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046042207R00000X, 207RN0300X
CAC198750207RN0300X
ORMD22973207RN0300X
SC35551207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC355519Medicaid
WA8288912Medicaid
CA0100970Medicaid
OR287621Medicaid
OR287621Medicaid
ORR109703Medicare PIN