Provider Demographics
NPI:1588626584
Name:RAJAN, PADMINI G (MD)
Entity type:Individual
Prefix:
First Name:PADMINI
Middle Name:G
Last Name:RAJAN
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 1:300 RIVERSIDE DR E
Mailing Address - Street 2:STE 3900
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1097
Mailing Address - Country:US
Mailing Address - Phone:941-748-4847
Mailing Address - Fax:941-748-4827
Practice Address - Street 1:712 53RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-5827
Practice Address - Country:US
Practice Address - Phone:941-755-2456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049009207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04502OtherBLUE CROSS/BLUE SHEILD
FL046898300Medicaid
10718522OtherCAQH
10718522OtherCAQH
D20936Medicare UPIN