Provider Demographics
NPI:1598143943
Name:NAGARAJ, AADITYA
Entity Type:Individual
Prefix:
First Name:AADITYA
Middle Name:
Last Name:NAGARAJ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 BRAESWOOD PARK DR APT 259
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4432
Mailing Address - Country:US
Mailing Address - Phone:214-693-0633
Mailing Address - Fax:
Practice Address - Street 1:ONE BAYLOR PLAZA, BCM 620
Practice Address - Street 2:BAYLOR COLLEGE OF MEDICINE, ME
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-798-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10052922207R00000X
TXT17872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX592014OtherTEXAS MEDICAL BOARD PHYSICIAN IN TRAINING