Provider Demographics
NPI:1194510016
Name:RAVI RAJA MALAR VANNAN, JUDAH RAJENDRAN (MD)
Entity type:Individual
Prefix:DR
First Name:JUDAH RAJENDRAN
Middle Name:
Last Name:RAVI RAJA MALAR VANNAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:JUDAH
Other - Middle Name:
Other - Last Name:RAJENDRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:CREIGHTON UNIVERSITY
Mailing Address - Street 2:3100 N. CENTRAL AVENUE
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012
Mailing Address - Country:US
Mailing Address - Phone:216-338-5003
Mailing Address - Fax:
Practice Address - Street 1:350 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4409
Practice Address - Country:US
Practice Address - Phone:216-338-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program