1659665305 NPI number — DR. GEETHA LAKSHMI RADHAKRISHNAN MD

Table of content: DR. GEETHA LAKSHMI RADHAKRISHNAN MD (NPI 1659665305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659665305 NPI number — DR. GEETHA LAKSHMI RADHAKRISHNAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RADHAKRISHNAN
Provider First Name:
GEETHA
Provider Middle Name:
LAKSHMI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAMASWAMY
Provider Other First Name:
GEETHA
Provider Other Middle Name:
LAKSHMI
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659665305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
UTMB CHILDREN'S HOSPITAL 3.230
Provider Business Mailing Address City Name:
GALVESTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77555-0354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-747-0534
Provider Business Mailing Address Fax Number:
409-747-0721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
UTMB CHILDREN'S HOSPITAL 3.230
Provider Business Practice Location Address City Name:
GALVESTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77555-0354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-747-0534
Provider Business Practice Location Address Fax Number:
409-747-0721
Provider Enumeration Date:
05/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  BP1-0040962 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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