Provider Demographics
NPI:1578501623
Name:SAXENA, SHRAVAN RAJ (MD)
Entity type:Individual
Prefix:
First Name:SHRAVAN
Middle Name:RAJ
Last Name:SAXENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 HOLLAND AVE
Mailing Address - Street 2:VA MEDICAL CTR
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-626-6620
Mailing Address - Fax:518-626-5916
Practice Address - Street 1:326 S PEARL ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12202-1914
Practice Address - Country:US
Practice Address - Phone:518-449-0100
Practice Address - Fax:518-463-8580
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY219991207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000407996002OtherHEALTH NOW - BLUE SHIELD