Provider Demographics
NPI:1023226610
Name:TAMBYRAJA, RABINDRA R (MD)
Entity type:Individual
Prefix:
First Name:RABINDRA
Middle Name:R
Last Name:TAMBYRAJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:SUITE F256/2B WEST
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-273-9711
Mailing Address - Fax:612-273-9779
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:SUITE F256/2B WEST
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-273-9711
Practice Address - Fax:612-273-9779
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTC 57-01-0938390200000X
OH900242084P0800X
MN532102084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry