Provider Demographics
NPI:1669692059
Name:PACKIANATHAN, XAVIER RAJESH (MD)
Entity type:Individual
Prefix:DR
First Name:XAVIER
Middle Name:RAJESH
Last Name:PACKIANATHAN
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 1:116 REDONDO DE FRANCISCO ST
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3718
Mailing Address - Country:US
Mailing Address - Phone:671-483-9226
Mailing Address - Fax:
Practice Address - Street 1:633 GOV CARLOS CAMACHO RD
Practice Address - Street 2:SUITE 210
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-649-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD425822085R0202X, 2085R0204X
GUM-19442085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology