Provider Demographics
NPI:1609803956
Name:RUDRARAJU, MADHAVI (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHAVI
Middle Name:
Last Name:RUDRARAJU
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 1:8109 FREDERICKSBURG RD
Mailing Address - Street 2:PHYSICIAN PRACTICE SERVICES
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3311
Mailing Address - Country:US
Mailing Address - Phone:210-575-8514
Mailing Address - Fax:210-575-8004
Practice Address - Street 1:8201 EWING HALSELL DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3707
Practice Address - Country:US
Practice Address - Phone:210-575-8514
Practice Address - Fax:210-575-8004
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5374207RG0100X, 207RI0008X, 207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219652902OtherCSHCN
TX8CJ296OtherBCBS
P00996225OtherMEDICARE RAILROAD
TX219652901Medicaid
TX219652902OtherCSHCN