Provider Demographics
NPI:1215988514
Name:RAJU-SWAMI, RATHNA (MD)
Entity type:Individual
Prefix:
First Name:RATHNA
Middle Name:
Last Name:RAJU-SWAMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 EAST PEARL STREET
Mailing Address - Street 2:PO BOX 9696
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002
Mailing Address - Country:US
Mailing Address - Phone:307-733-2350
Mailing Address - Fax:307-733-2953
Practice Address - Street 1:155 EAST PEARL STREET
Practice Address - Street 2:SUITE 12
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83002
Practice Address - Country:US
Practice Address - Phone:307-733-2350
Practice Address - Fax:307-733-2953
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6864A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY120550100Medicaid
W20047Medicare ID - Type Unspecified
H49409Medicare UPIN