Provider Demographics
NPI:1073775524
Name:KERIWALA, RAJ DILIP (MD)
Entity Type:Individual
Prefix:
First Name:RAJ
Middle Name:DILIP
Last Name:KERIWALA
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 1:1301 W 38TH ST STE 700
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1016
Mailing Address - Country:US
Mailing Address - Phone:512-324-3340
Mailing Address - Fax:
Practice Address - Street 1:1301 W 38TH ST STE 700
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1016
Practice Address - Country:US
Practice Address - Phone:512-324-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0243207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285053901Medicaid
TX285053902Medicaid
TXTXB140513Medicare PIN
TX452830YKRYMedicare PIN
TXP01009472Medicare PIN
TX285053902Medicaid