Provider Demographics
NPI:1235154204
Name:SELVARAJ, SENTHILNATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SENTHILNATHAN
Middle Name:
Last Name:SELVARAJ
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 1:4800 MEMORIAL DRIVE
Mailing Address - Street 2:AMBULATORY CARE. WACO VAMC,
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76711
Mailing Address - Country:US
Mailing Address - Phone:325-277-9997
Mailing Address - Fax:325-277-2823
Practice Address - Street 1:4800 MEMORIAL DR
Practice Address - Street 2:WACO VAMC,
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-1329
Practice Address - Country:US
Practice Address - Phone:325-277-9997
Practice Address - Fax:325-277-2823
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA40996207RG0300X
TXK6309207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine