Provider Demographics
NPI:1033117817
Name:BOORGU, RAJESH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:
Last Name:BOORGU
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 1:422 E DR HICKS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5763
Mailing Address - Country:US
Mailing Address - Phone:256-766-1401
Mailing Address - Fax:256-766-1402
Practice Address - Street 1:422 E DR HICKS BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5763
Practice Address - Country:US
Practice Address - Phone:256-766-1401
Practice Address - Fax:256-766-1402
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000020221207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000076742Medicaid
AL529400760Medicaid
SC110208939OtherMEDICARE RAILROAD/PALMETTO GBA - INDIVIDUAL
SCCC6102OtherMEDICARE RAILROAD/PALMETTO GBA - GROUP
SCCC6102OtherMEDICARE RAILROAD/PALMETTO GBA - GROUP
AL529400760Medicaid