Provider Demographics
NPI:1861792558
Name:RAVEENDRA NADARAJA, M.D., F.A.C.S., INC.
Entity type:Organization
Organization Name:RAVEENDRA NADARAJA, M.D., F.A.C.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GOWRI
Authorized Official - Middle Name:
Authorized Official - Last Name:NADARAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-538-2146
Mailing Address - Street 1:20055 LAKE CHABOT RD STE 330
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5334
Mailing Address - Country:US
Mailing Address - Phone:510-538-2146
Mailing Address - Fax:510-538-7959
Practice Address - Street 1:20055 LAKE CHABOT RD STE 330
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5334
Practice Address - Country:US
Practice Address - Phone:510-538-2146
Practice Address - Fax:510-538-7959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty