Provider Demographics
NPI:1790882488
Name:RAJ, GANESH VENKATARAMAN (MD PHD)
Entity type:Individual
Prefix:
First Name:GANESH
Middle Name:VENKATARAMAN
Last Name:RAJ
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:VARADARAJAN
Other - Middle Name:GANESH
Other - Last Name:VENKATARAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:605 E SAN ANTONIO ST STE 509E
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6079
Mailing Address - Country:US
Mailing Address - Phone:361-573-6351
Mailing Address - Fax:361-575-6455
Practice Address - Street 1:605 E SAN ANTONIO ST STE 509E
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6079
Practice Address - Country:US
Practice Address - Phone:361-573-6351
Practice Address - Fax:361-575-6455
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3259208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology