Provider Demographics
NPI:1326042250
Name:GUNDA, RAJESWARI (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESWARI
Middle Name:
Last Name:GUNDA
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 1:1400 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-2440
Mailing Address - Country:US
Mailing Address - Phone:419-783-3344
Mailing Address - Fax:419-783-2793
Practice Address - Street 1:1400 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2440
Practice Address - Country:US
Practice Address - Phone:419-783-3344
Practice Address - Fax:419-783-2793
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-03-07
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
OH35056652207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000296654OtherANTHEM BCBS
OH0713455Medicaid
OH36D1013073OtherCLIA
OHGU0616324OtherPIN #
OH496672001OtherADMINASTAR
OHP00034377OtherRAILROAD MEDICARE
OH3256419OtherAETNA
OH3256419OtherAETNA
OH000000296654OtherANTHEM BCBS
OH9334751Medicare ID - Type UnspecifiedMEDICAREQ
OH0713455Medicaid
OH4966720001Medicare NSC
OHGU0616325Medicare PIN