Provider Demographics
NPI:1427016294
Name:RAJASEKARAN, GANESAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GANESAN
Middle Name:
Last Name:RAJASEKARAN
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 1:4543 S MANHATTAN AVE
Mailing Address - Street 2:101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-2330
Mailing Address - Country:US
Mailing Address - Phone:813-837-0262
Mailing Address - Fax:813-837-0919
Practice Address - Street 1:4543 S MANHATTAN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-2330
Practice Address - Country:US
Practice Address - Phone:813-837-0262
Practice Address - Fax:813-837-0919
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME21922207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003077000Medicaid
FLD53751Medicare UPIN
FL003077000Medicaid