Provider Demographics
NPI:1992029466
Name:RAJAN, DIVYA SEETHARAM (MD PHD)
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:SEETHARAM
Last Name:RAJAN
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:DIVYA
Other - Middle Name:
Other - Last Name:SEETHARAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1935 MEDICAL DISTRICT DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7701
Mailing Address - Country:US
Mailing Address - Phone:214-456-0488
Mailing Address - Fax:214-456-4486
Practice Address - Street 1:1935 MEDICAL DISTRICT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:214-456-0488
Practice Address - Fax:214-456-4486
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP67022080N0001X, 208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program