Provider Demographics
NPI:1275541633
Name:SRINIVASAN, RAJASHREE (MD)
Entity Type:Individual
Prefix:
First Name:RAJASHREE
Middle Name:
Last Name:SRINIVASAN
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 1:3301 SWISS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204
Mailing Address - Country:US
Mailing Address - Phone:214-820-9800
Mailing Address - Fax:214-820-9878
Practice Address - Street 1:3301 SWISS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204
Practice Address - Country:US
Practice Address - Phone:214-820-9800
Practice Address - Fax:214-820-9878
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL31402081P0010X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147888506Medicaid
TX8BR152OtherBCBS
TX147888505Medicaid
TXL3140OtherTSBME
TXL3140OtherTSBME
TX8J6532Medicare PIN
TX8L2997Medicare PIN
TX147888505Medicaid