Provider Demographics
NPI:1104024371
Name:RUDRARAJU, SMITHA (MD)
Entity Type:Individual
Prefix:
First Name:SMITHA
Middle Name:
Last Name:RUDRARAJU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 ALLIANCE BOULEVARD
Mailing Address - Street 2:STE 775
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5371
Mailing Address - Country:US
Mailing Address - Phone:469-800-6069
Mailing Address - Fax:469-800-6061
Practice Address - Street 1:4716 ALLIANCE BLVD STE 775
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:469-800-6000
Practice Address - Fax:469-800-6000
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5984207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217842801Medicaid
TX217842802Medicaid
TXP00882615OtherRAILROAD MEDICARE
TX217842801Medicaid