Provider Demographics
NPI:1225344054
Name:RAJDERKAR, DHANASHREE ABHIJIT (MD)
Entity Type:Individual
Prefix:DR
First Name:DHANASHREE
Middle Name:ABHIJIT
Last Name:RAJDERKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DHANASHREE
Other - Middle Name:SUBHASCHANDRA
Other - Last Name:DANDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMRD,DNB
Mailing Address - Street 1:902 SW 88TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-4942
Mailing Address - Country:US
Mailing Address - Phone:314-971-7990
Mailing Address - Fax:
Practice Address - Street 1:6621 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2358
Practice Address - Country:US
Practice Address - Phone:832-824-8440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1187272085P0229X, 207U00000X
MO20100086072085P0229X, 207U00000X
TXU79352085R0202X, 2085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011821700Medicaid
FLHU478ZMedicare PIN