Provider Demographics
NPI:1326088592
Name:GOSWAMI, RAJIV (DO)
Entity Type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:
Last Name:GOSWAMI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 FROSTWOOD DR
Mailing Address - Street 2:SUITE 1.100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-338-5519
Mailing Address - Fax:
Practice Address - Street 1:17510 W GRAND PKWY S
Practice Address - Street 2:SUITE 510
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2645
Practice Address - Country:US
Practice Address - Phone:281-344-0856
Practice Address - Fax:281-344-0873
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230938-1207RC0000X, 207RI0011X, 207UN0901X
TXN3689207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02798772Medicaid
NY665AZ1OtherEMPIRE BLUE CROSS BLUE SHIELD
NY02798772Medicaid
8L0270Medicare PIN