Provider Demographics
NPI:1700886850
Name:RAJARAM, VEENA (MD)
Entity Type:Individual
Prefix:DR
First Name:VEENA
Middle Name:
Last Name:RAJARAM
Suffix:
Gender:F
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:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-456-2993
Mailing Address - Fax:214-456-0779
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:PATHOLOGY LAB
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-648-4125
Practice Address - Fax:214-648-4070
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4101207ZP0102X, 207ZP0213X, 207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111332Medicaid
ILI24469Medicare UPIN
IL702730Medicare PIN
ILK44313Medicare PIN