Provider Demographics
NPI:1750379608
Name:GANDHI, RAJENDRA T (MD)
Entity type:Individual
Prefix:
First Name:RAJENDRA
Middle Name:T
Last Name:GANDHI
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:PO BOX 37063
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71133-7063
Mailing Address - Country:US
Mailing Address - Phone:318-635-9855
Mailing Address - Fax:318-635-9857
Practice Address - Street 1:2551 GREENWOOD RD
Practice Address - Street 2:#220
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103
Practice Address - Country:US
Practice Address - Phone:318-635-9855
Practice Address - Fax:318-635-9857
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL005102R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1304476Medicaid
LA5J335Medicare ID - Type Unspecified
LA1304476Medicaid