Provider Demographics
NPI:1194777920
Name:GANDHI, RAJENDRA P (MD)
Entity type:Individual
Prefix:DR
First Name:RAJENDRA
Middle Name:P
Last Name:GANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:912 WRIGHT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4759
Mailing Address - Country:US
Mailing Address - Phone:817-274-7593
Mailing Address - Fax:817-261-4785
Practice Address - Street 1:912 WRIGHT ST
Practice Address - Street 2:SUITE B
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4759
Practice Address - Country:US
Practice Address - Phone:817-274-7593
Practice Address - Fax:817-261-4785
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF77612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88940XOtherBLUE SHIELD
TX0348567-02Medicaid
TXC15869Medicare UPIN
TX0348567-02Medicaid