Provider Demographics
NPI:1861580441
Name:KASTHURI, RAJ S (MBBS, MD)
Entity type:Individual
Prefix:
First Name:RAJ
Middle Name:S
Last Name:KASTHURI
Suffix:
Gender:M
Credentials:MBBS, MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:UNIVERITY OF NORTH CAROLINA
Mailing Address - Street 2:CB7035, 1047 GENETIC MEDICINE BLDG, 120 MASON FARM RD
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-0001
Mailing Address - Country:US
Mailing Address - Phone:919-966-3311
Mailing Address - Fax:919-843-4896
Practice Address - Street 1:UNIVERSITY OF NORTH CAROLINA HOSPITALS
Practice Address - Street 2:101 MANNING DRIVE
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-966-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44740207R00000X
NC2007-01374207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1044848OtherPREFERRED ONE
MN36-00611OtherMEDICA-CHOICE
WI34802800Medicaid
MN499368OtherFAIRVIEW
MN135164OtherU CARE
MN36-00013OtherMEDICA-PRIMARY
B619OtherCHAMPUS
MT0147747Medicaid
MN2378190OtherARAZ
P00282875OtherRR MEDICARE
MNHP55120OtherHEALTH PARTNERS
MT0147747Medicaid
MT0147747Medicaid