Provider Demographics
NPI:1013977925
Name:RAJA, HARIKRISHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:HARIKRISHNA
Middle Name:
Last Name:RAJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HARI
Other - Middle Name:
Other - Last Name:RAJA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:440 W LYNDON B JOHNSON FWY STE 405
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3710
Mailing Address - Country:US
Mailing Address - Phone:972-993-5080
Mailing Address - Fax:972-993-5081
Practice Address - Street 1:440 W LYNDON B JOHNSON FWY STE 405
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3710
Practice Address - Country:US
Practice Address - Phone:972-993-5080
Practice Address - Fax:972-993-5081
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1013977925OtherNPI
TX1206559-05Medicaid
TX1992700512OtherGROUP NPI
TX1206559-05Medicaid
G66876Medicare UPIN