Provider Demographics
NPI:1932288958
Name:TADIMALLA, RAJANI S (MD)
Entity Type:Individual
Prefix:
First Name:RAJANI
Middle Name:S
Last Name:TADIMALLA
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 1:912 WASHINGTON RD
Mailing Address - Street 2:HUNTER PROF. CENTER
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5827
Mailing Address - Country:US
Mailing Address - Phone:410-848-4121
Mailing Address - Fax:
Practice Address - Street 1:912 WASHINGTON RD
Practice Address - Street 2:HUNTER PROF. CENTER
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5827
Practice Address - Country:US
Practice Address - Phone:410-848-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H69383Medicare UPIN
MD124LMedicare ID - Type Unspecified