Provider Demographics
NPI:1639132558
Name:RAJACHANDRAN, MANU S (MD)
Entity Type:Individual
Prefix:DR
First Name:MANU
Middle Name:S
Last Name:RAJACHANDRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3270 JOE BATTLE BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2622
Mailing Address - Country:US
Mailing Address - Phone:915-206-2999
Mailing Address - Fax:915-249-2716
Practice Address - Street 1:4801 ALBERTA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2707
Practice Address - Country:US
Practice Address - Phone:915-215-5200
Practice Address - Fax:915-215-8640
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5348207RC0000X, 207RI0011X
PAMD439156207RI0011X
NJ25MA06950200207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102446101Medicaid
NJ8081603Medicaid
NJ030024BVPMedicare ID - Type Unspecified
NJG53147Medicare UPIN