Provider Demographics
NPI:1336423169
Name:RAJA NAIDU MD PA
Entity Type:Organization
Organization Name:RAJA NAIDU MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:RAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-617-8329
Mailing Address - Street 1:605 E. 4TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5100
Mailing Address - Country:US
Mailing Address - Phone:432-617-8329
Mailing Address - Fax:432-339-8454
Practice Address - Street 1:605 E. 4TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5100
Practice Address - Country:US
Practice Address - Phone:432-617-8329
Practice Address - Fax:432-339-8454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty