Provider Demographics
NPI:1831726835
Name:RAJAGANAPATHY, SRINIVASAN (MD)
Entity type:Individual
Prefix:
First Name:SRINIVASAN
Middle Name:
Last Name:RAJAGANAPATHY
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 1:3453 MONTEGO BAY LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2785
Mailing Address - Country:US
Mailing Address - Phone:936-718-6221
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CITY FORT WORTH
Practice Address - Street 2:900 8TH AVENUE
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3902
Practice Address - Country:US
Practice Address - Phone:817-336-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program