Provider Demographics
NPI:1730702515
Name:MURALI, RAJA DAMAYANTHI
Entity type:Individual
Prefix:
First Name:RAJA DAMAYANTHI
Middle Name:
Last Name:MURALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5050
Mailing Address - Country:US
Mailing Address - Phone:479-314-4810
Mailing Address - Fax:479-314-4829
Practice Address - Street 1:3224 S 70TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5050
Practice Address - Country:US
Practice Address - Phone:479-314-4810
Practice Address - Fax:479-314-4829
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARE-16929208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program