Provider Demographics
NPI:1821327586
Name:RAJU, MADHAVI SAMANTHAPUDI (PA)
Entity Type:Individual
Prefix:MRS
First Name:MADHAVI
Middle Name:SAMANTHAPUDI
Last Name:RAJU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:19875 SOUTHWEST FWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3502
Mailing Address - Country:US
Mailing Address - Phone:281-545-2323
Mailing Address - Fax:
Practice Address - Street 1:19875 SOUTHWEST FREEWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-545-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06503363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical